Provider Demographics
NPI:1508577677
Name:MESSICK, NICOLE LEE (MLSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MESSICK
Suffix:
Gender:F
Credentials:MLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 SKUNA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9667
Mailing Address - Country:US
Mailing Address - Phone:719-301-7544
Mailing Address - Fax:
Practice Address - Street 1:6728 SKUNA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-9667
Practice Address - Country:US
Practice Address - Phone:248-396-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2023-12-19
Deactivation Date:2023-11-20
Deactivation Code:
Reactivation Date:2023-12-19
Provider Licenses
StateLicense IDTaxonomies
CO00099217771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical