Provider Demographics
NPI:1629718762
Name:RIKKI OLI CLOS
Entity Type:Organization
Organization Name:RIKKI OLI CLOS
Other - Org Name:MATTIE CLOS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:OLI
Authorized Official - Last Name:CLOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-580-0393
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000204562Medicaid