Provider Demographics
NPI:1215289079
Name:WILSON, ELIZABETH (MS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S BROADWAY
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1582
Mailing Address - Country:US
Mailing Address - Phone:720-284-8582
Mailing Address - Fax:
Practice Address - Street 1:1212 S BROADWAY
Practice Address - Street 2:SUITE # 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1582
Practice Address - Country:US
Practice Address - Phone:720-284-8582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health