Provider Demographics
NPI:1275768285
Name:WILSON, HEIDI (MBA, MA, LPC, CACII)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MBA, MA, LPC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 30TH ST STE A
Mailing Address - Street 2:PMB 217
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1045
Mailing Address - Country:US
Mailing Address - Phone:720-530-8227
Mailing Address - Fax:303-927-6016
Practice Address - Street 1:1137 PEARL ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5159
Practice Address - Country:US
Practice Address - Phone:720-530-8227
Practice Address - Fax:303-927-6016
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6191101YA0400X
4075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)