=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629410303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI-LYNN NMN WILSON MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2013
-----------------------------------------------------
Last Update Date | 06/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 W US HIGHWAY 24 SUITE 232
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80863-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-233-3301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 WEST HWY 24 SUITE 232
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80863-9732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-233-3301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | NLC 103661
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------