Provider Demographics
NPI:1427661164
Name:NICHOLAS BOEDER - LCSW
Entity type:Organization
Organization Name:NICHOLAS BOEDER - LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-770-0436
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0473
Mailing Address - Country:US
Mailing Address - Phone:575-770-0436
Mailing Address - Fax:
Practice Address - Street 1:3921 BINGHAM HILL RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-1025
Practice Address - Country:US
Practice Address - Phone:575-770-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty