Provider Demographics
NPI:1720355019
Name:MCLEAN, NICOLE K (CAC II)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:K
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 SILVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6431
Mailing Address - Country:US
Mailing Address - Phone:970-223-2517
Mailing Address - Fax:
Practice Address - Street 1:1155 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3632
Practice Address - Country:US
Practice Address - Phone:303-436-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)