# COLORADO PSYCH CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851032643
- **Authorized official:** JACOB ALLEN WILSON PMHNP-BC (OWNER)
- **Authorized official phone:** (719) 726-1077

## Contact information

- **Practice address:** 615 N NEVADA AVE STE 1E, COLORADO SPRINGS, CO 80903-1075
- **Practice address phone:** (719) 726-1077
- **Practice address fax:** (719) 960-2933
- **Mailing address:** 615 N NEVADA AVE STE 1E, COLORADO SPRINGS, CO 80903-1075
- **Mailing address phone:** (719) 726-1077
- **Mailing address fax:** (719) 960-2933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/05/2022
- **Last updated:** 04/15/2026