Basic Information
| Provider Information | |||||||||
| NPI: | 1366596371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICKEL | ||||||||
| FirstName: | DOLORES | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.S. LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 ONEAL CIR APT L25 | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803011472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325021 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4851 INDEPENDENCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325021 | ||||||||
| FaxNumber: | 3034325071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3867 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.