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General NPI Number Information
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NPI Number | 1316158017
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Entity Type | Individual
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Provider Name | BEVERLY WILSON LCSW LICENSED CLINIC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8400 EAST PRENTICE AVENUE SUITE 1401
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2926
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Country | US
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Telephone | 303-986-6814
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Fax | 303-414-1111
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Provider Business Mailing Address
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Address Line | 2620 SOUTH JERSEY STREET
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City | DENVER
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State | CO
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Zip | 80222-6322
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Country | US
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Telephone | 303-756-6271
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Fax | 303-414-1111
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 986039
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License Number State | CO
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