Provider Demographics
NPI:1730647033
Name:WILSON, EVIE NOELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:EVIE
Middle Name:NOELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:EVIE
Other - Middle Name:NOELLE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10730 E BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2644
Mailing Address - Country:US
Mailing Address - Phone:720-634-9431
Mailing Address - Fax:
Practice Address - Street 1:390 UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-6514
Practice Address - Country:US
Practice Address - Phone:303-989-8169
Practice Address - Fax:303-984-4366
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-22-57807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician