Provider Demographics
NPI:1316636236
Name:JULIE L WILSON LLC
Entity type:Organization
Organization Name:JULIE L WILSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-493-8843
Mailing Address - Street 1:225 E CHEYENNE MOUNTAIN BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3700
Mailing Address - Country:US
Mailing Address - Phone:719-493-8843
Mailing Address - Fax:
Practice Address - Street 1:4955 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3265
Practice Address - Country:US
Practice Address - Phone:719-392-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIE L WILSON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty