Healthcare Provider Details

I. General information

NPI: 1477949337
Provider Name (Legal Business Name): WILLIAM EDWARD WIMSATT JR. LCSW, CAC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 COLORADO AVE
GRAND JUNCTION CO
81501-3523
US

IV. Provider business mailing address

1170 COLORADO AVE
GRAND JUNCTION CO
81501-3523
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-2948
  • Fax:
Mailing address:
  • Phone: 970-241-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00000753
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0007079
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: