Provider Demographics
NPI:1013034297
Name:WILSON, JOEY M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9189 SOUTH TURKEY CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:303-697-5049
Mailing Address - Fax:303-697-5083
Practice Address - Street 1:9189 S TURKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-9422
Practice Address - Country:US
Practice Address - Phone:303-697-5049
Practice Address - Fax:303-697-5083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional