Provider Demographics
NPI:1598901043
Name:WOOTEN, WILLFORD DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLFORD
Middle Name:DEAN
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 DAWNVIEW CT.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4508
Mailing Address - Country:US
Mailing Address - Phone:719-330-8040
Mailing Address - Fax:719-266-0447
Practice Address - Street 1:7610 N. UNION BLVD.
Practice Address - Street 2:SUITE 145
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-330-8040
Practice Address - Fax:719-266-0447
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9896961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical