Provider Demographics
NPI:1497255327
Name:WILSON, ERIC (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002-B FOSSIL CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FOSSIL CREEK PKWY
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:720-232-3459
Mailing Address - Fax:
Practice Address - Street 1:300 E HORSETOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3154
Practice Address - Country:US
Practice Address - Phone:720-232-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional