Provider Demographics
NPI:1831664150
Name:WILSON, BETHANY (LPC, BCN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W MINERAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4544
Mailing Address - Country:US
Mailing Address - Phone:303-775-3684
Mailing Address - Fax:
Practice Address - Street 1:1221 W MINERAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4544
Practice Address - Country:US
Practice Address - Phone:303-775-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional