Provider Demographics
NPI:1770256539
Name:NICHOLS, ALISE LUCILLE
Entity Type:Individual
Prefix:
First Name:ALISE
Middle Name:LUCILLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISE
Other - Middle Name:LUCILLE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2929 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3363
Mailing Address - Country:US
Mailing Address - Phone:303-504-1278
Mailing Address - Fax:303-504-7991
Practice Address - Street 1:2929 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3363
Practice Address - Country:US
Practice Address - Phone:303-504-1278
Practice Address - Fax:303-504-7991
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool