MEDICARE: MS. NIKI A WORTHAN MA, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	ACD1186	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD1186	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ACD1186	OTHER	CO	LICENSE

General Provider Information

NPI Number	:	1194250407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIKI A WORTHAN MA, LAC

Provider Business Mailing Address
First Line	:	6655 W JEWELL AVE STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-7108
Country	:	US
Telephone Number	:	303-975-1922
Fax Number	:	303-975-1918

Provider Business Practice Location Address
First Line	:	6655 W JEWELL AVE STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-7108
Country	:	US
Telephone Number	:	303-975-1922
Fax Number	:	303-975-1918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	12/11/2025

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