Healthcare Provider Details

I. General information

NPI: 1801241070
Provider Name (Legal Business Name): NICOLE SIMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 INTERLOCKEN BLVD STE 106
BROOMFIELD CO
80021-3409
US

IV. Provider business mailing address

603 LOWELL BLVD
DENVER CO
80204-3101
US

V. Phone/Fax

Practice location:
  • Phone: 720-773-8727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002404
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0021374
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0003289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: