Provider Demographics
NPI:1629013511
Name:READ, NANCY OLIVER (PHD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:OLIVER
Last Name:READ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4232
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-4232
Mailing Address - Country:US
Mailing Address - Phone:218-355-0536
Mailing Address - Fax:
Practice Address - Street 1:100 W. COLORADO AVE
Practice Address - Street 2:SUITE 240F
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-4232
Practice Address - Country:US
Practice Address - Phone:218-355-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00672103TC1900X
MNLP4732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN735340500Medicaid
MN129336OtherVALUE OPTIONS
IA48732OtherWELLMARK PROVIDER NUMBER
MN79G94REOtherBLUECROSS BLUESHIELD
IA7523OtherMIDLANDS CHOICE PROVIDER
MNHP71696OtherHEALTH PARTNERS
MNHP71696OtherHEALTH PARTNERS