Basic Information
| Provider Information | |||||||||
| NPI: | 1578879995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OVALLES-WILSON | ||||||||
| FirstName: | KEILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 PARADISE RD | ||||||||
| Address2: | SUITE 1F | ||||||||
| City: | SWAMPSCOTT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019071356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812281093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 METHUEN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018401700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833128 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.