Provider Demographics
NPI:1477959237
Name:WILSON, LEE ANN
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:MACVEETY/ JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR
Mailing Address - Street 2:STE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8700
Mailing Address - Country:US
Mailing Address - Phone:970-683-7107
Mailing Address - Fax:970-683-7167
Practice Address - Street 1:450 OURAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2536
Practice Address - Country:US
Practice Address - Phone:970-241-6099
Practice Address - Fax:970-241-0797
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor