Healthcare Provider Details

I. General information

NPI: 1578492955
Provider Name (Legal Business Name): NATHANIEL BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 E GIRARD AVE STE 4350
AURORA CO
80014-5001
US

IV. Provider business mailing address

2962 S PARKER CT
AURORA CO
80014-3058
US

V. Phone/Fax

Practice location:
  • Phone: 303-598-2391
  • Fax:
Mailing address:
  • Phone: 303-598-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0023006
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: