Provider Demographics
NPI:1679972442
Name:NICHOLAS SIMPSON, LLC
Entity Type:Organization
Organization Name:NICHOLAS SIMPSON, LLC
Other - Org Name:BROOMFIELD INTEGRATIVE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-254-3050
Mailing Address - Street 1:884 W CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9570
Mailing Address - Country:US
Mailing Address - Phone:720-254-3050
Mailing Address - Fax:
Practice Address - Street 1:11001 W 120TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3494
Practice Address - Country:US
Practice Address - Phone:720-254-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1477943322OtherINDIVIDUAL NPI