Provider Demographics
NPI:1629471883
Name:GURASH, NICOLE (PSYD, LMFT, BCBA)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GURASH
Suffix:
Gender:F
Credentials:PSYD, LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9362 TEDDY LN STE 206
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2871
Mailing Address - Country:US
Mailing Address - Phone:720-282-9151
Mailing Address - Fax:
Practice Address - Street 1:9362 TEDDY LN STE 206
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2871
Practice Address - Country:US
Practice Address - Phone:720-282-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-9539103K00000X
COMFT.0002102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst