Provider Demographics
NPI:1285956359
Name:FENTON-NICHOLS, DEBORAH LOUISE (LPC, LAC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LOUISE
Last Name:FENTON-NICHOLS
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2124
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2124
Mailing Address - Country:US
Mailing Address - Phone:970-443-1038
Mailing Address - Fax:
Practice Address - Street 1:300 E. BOARDWALK DRIVE
Practice Address - Street 2:BUILDING 6A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3093
Practice Address - Country:US
Practice Address - Phone:970-443-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332101YA0400X
CO5358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)