Provider Demographics
NPI:1699088492
Name:WILLMER, STEPHEN PAUL (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:WILLMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BERTHOUD WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4815
Mailing Address - Country:US
Mailing Address - Phone:303-942-0726
Mailing Address - Fax:
Practice Address - Street 1:720 KIPLING ST STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5866
Practice Address - Country:US
Practice Address - Phone:303-942-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8521041C0700X
CO04675101041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool