Provider Demographics
NPI:1073252409
Name:WHILDES, CARSON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:WHILDES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:
Other - Last Name:WILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:627 KIMBARK ST. #1
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:515-229-7875
Mailing Address - Fax:
Practice Address - Street 1:627 KIMBARK ST # 1
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4910
Practice Address - Country:US
Practice Address - Phone:515-229-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health