Healthcare Provider Details

I. General information

NPI: 1407513492
Provider Name (Legal Business Name): CONNOR T WILSON BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 POPLAR ST
LEADVILLE CO
80461-3059
US

IV. Provider business mailing address

10650 E BETHANY DR
AURORA CO
80014-2653
US

V. Phone/Fax

Practice location:
  • Phone: 720-584-8055
  • Fax:
Mailing address:
  • Phone: 720-584-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: