Provider Demographics
NPI:1235300781
Name:WILSON, TRUDY G (LPC)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:G
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 253
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8732
Mailing Address - Country:US
Mailing Address - Phone:719-634-1825
Mailing Address - Fax:719-634-1874
Practice Address - Street 1:1633 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 253
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8732
Practice Address - Country:US
Practice Address - Phone:719-634-1825
Practice Address - Fax:719-634-1874
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001201101YP2500X
CO5518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional