Provider Demographics
NPI:1033762091
Name:CLOS, RIKKI (LCSW)
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:
Last Name:CLOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 ARAPAHOE ROAD
Mailing Address - Street 2:STE 132 - MAILBOX 700
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8016
Mailing Address - Country:US
Mailing Address - Phone:720-580-0393
Mailing Address - Fax:
Practice Address - Street 1:2770 ARAPAHOE RD STE 132
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8016
Practice Address - Country:US
Practice Address - Phone:720-580-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2022-09-25
Deactivation Date:2022-03-29
Deactivation Code:
Reactivation Date:2022-07-11
Provider Licenses
StateLicense IDTaxonomies
COCSW.09927791261QM0850X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1629718762Medicaid