Provider Demographics
NPI:1194250407
Name:WORTHAN, NIKI A (MA, LAC)
Entity type:Individual
Prefix:MS
First Name:NIKI
Middle Name:A
Last Name:WORTHAN
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 W JEWELL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7190
Mailing Address - Country:US
Mailing Address - Phone:303-975-1922
Mailing Address - Fax:303-975-1918
Practice Address - Street 1:6655 W JEWELL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7190
Practice Address - Country:US
Practice Address - Phone:303-975-1922
Practice Address - Fax:303-975-1918
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD1186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)