Healthcare Provider Details

I. General information

NPI: 1619699741
Provider Name (Legal Business Name): ELIZABETH NIX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: E.B. NIX LCSW

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOUTHSIDE DR
BASALT CO
81621-9131
US

IV. Provider business mailing address

PO BOX 339
GLENWOOD SPRINGS CO
81602-0339
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2840
  • Fax: 970-945-2893
Mailing address:
  • Phone: 970-945-2840
  • Fax: 970-945-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931105
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: