Basic Information
Provider Information | |||||||||
NPI: | 1447249776 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NICHOLSON | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | MOSIER | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA, LCPC, LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 453 E WONDER VIEW AVE | ||||||||
Address2: | PMB 146 | ||||||||
City: | ESTES PARK | ||||||||
State: | CO | ||||||||
PostalCode: | 805179647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9705770606 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 928 12TH ST | ||||||||
Address2: |   | ||||||||
City: | GREELEY | ||||||||
State: | CO | ||||||||
PostalCode: | 806314024 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9703521056 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2687 | CO | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2000164975 | MO | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 092 | KS | N |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.