Individual
MR. BRYCE CRAIG WILLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, CACIII, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5782
CO
101YM0800X
Mental Health Counselor
2955
CO
103TC0700X
Clinical Psychologist
Primary
3874
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11638726
CAQH
CO
01
—
3874
PROFESSIONAL LICENSE
CO
Enumeration date
10/04/2005
Last updated
04/18/2016
Update your record
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