Provider Demographics
NPI:1588814529
Name:WILSON, WESLEY ROWLAND (LMFT, LAC, AAMFT SUP)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:ROWLAND
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMFT, LAC, AAMFT SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 KINDERHOOK LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3870
Mailing Address - Country:US
Mailing Address - Phone:719-331-3338
Mailing Address - Fax:719-599-9001
Practice Address - Street 1:2515 KINDERHOOK LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3870
Practice Address - Country:US
Practice Address - Phone:719-331-3338
Practice Address - Fax:719-599-9001
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD -272101YA0400X
CO922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD -272OtherDORA, DEPT. OF REGULATED AGENDIES
COMFT-922OtherDORA, DEPT. OF REGULATED AGENDIES