Provider Demographics
NPI:1568066744
Name:LONGHOFER, NICOLE LEA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:LONGHOFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 DELMONICO DR STE D210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1899
Mailing Address - Country:US
Mailing Address - Phone:330-488-5297
Mailing Address - Fax:
Practice Address - Street 1:1295 KELLY JOHNSON BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3963
Practice Address - Country:US
Practice Address - Phone:719-480-8848
Practice Address - Fax:719-941-8256
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021651101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health