Provider Demographics
NPI:1104232982
Name:NICOLL, MARY (LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NICOLL
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E 10TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3251
Mailing Address - Country:US
Mailing Address - Phone:303-500-3847
Mailing Address - Fax:
Practice Address - Street 1:190 E 9TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2737
Practice Address - Country:US
Practice Address - Phone:303-500-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0013641 (PERMIT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health