Healthcare Provider Details

I. General information

NPI: 1376042051
Provider Name (Legal Business Name): AMBER NICOLETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 RALSTON RD
ARVADA CO
80002-2431
US

IV. Provider business mailing address

7485 REED ST
ARVADA CO
80003-2747
US

V. Phone/Fax

Practice location:
  • Phone: 720-675-8797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024575
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0021063
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: