Healthcare Provider Details

I. General information

NPI: 1013034297
Provider Name (Legal Business Name): JOEY M WILSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9189 S TURKEY CREEK RD
MORRISON CO
80465-9422
US

IV. Provider business mailing address

9189 SOUTH TURKEY CREEK ROAD
MORRISON CO
80465
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-5049
  • Fax: 303-697-5083
Mailing address:
  • Phone: 303-697-5049
  • Fax: 303-697-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4604
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: