Provider Demographics
NPI:1982465076
Name:COSNER, WAYLON (LPCC)
Entity type:Individual
Prefix:
First Name:WAYLON
Middle Name:
Last Name:COSNER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8422 WOODLANDS WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-3210
Mailing Address - Country:US
Mailing Address - Phone:720-771-7846
Mailing Address - Fax:
Practice Address - Street 1:6557 BUTTERCUP DR UNIT 5
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2413
Practice Address - Country:US
Practice Address - Phone:720-805-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health