MEDICARE: PHYLLIS WILNER M.A., L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962558601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS WILNER M.A., L.P.C.

Provider Business Mailing Address
First Line	:	1635 FOXTRAIL DR # 339
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9086
Country	:	US
Telephone Number	:	303-931-2941
Fax Number	:	303-772-4559

Provider Business Practice Location Address
First Line	:	1635 FOXTRAIL DR # 339
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9086
Country	:	US
Telephone Number	:	303-931-2941
Fax Number	:	303-772-4559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	10/24/2011

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