Provider Demographics
NPI:1366596371
Name:NICKEL, DOLORES J (MS LPC)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:J
Last Name:NICKEL
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 ONEAL CIR APT L25
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1472
Mailing Address - Country:US
Mailing Address - Phone:303-432-5021
Mailing Address - Fax:
Practice Address - Street 1:4851 INDEPENDENCE ST STE 200
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6712
Practice Address - Country:US
Practice Address - Phone:303-432-5021
Practice Address - Fax:303-432-5071
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional