Basic Information
| Provider Information | |||||||||
| NPI: | 1437510906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERMEER | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2551 S. PAGOSA WAY | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207372933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15001 E OXFORD AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800144186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036931550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2016 | ||||||||
| LastUpdateDate: | 03/11/2016 | ||||||||
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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 | 101Y00000X | CO | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 53239873 | 05 | CO | MEDICAID |