Healthcare Provider Details

I. General information

NPI: 1417872912
Provider Name (Legal Business Name): BETSY J WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 48TH ST STE 120
WEST DES MOINES IA
50266-6723
US

IV. Provider business mailing address

520 11TH ST
WEST DES MOINES IA
50265-4428
US

V. Phone/Fax

Practice location:
  • Phone: 515-331-0303
  • Fax: 515-331-9086
Mailing address:
  • Phone: 515-331-0303
  • Fax: 515-331-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number132039
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: