Healthcare Provider Details

I. General information

NPI: 1952295842
Provider Name (Legal Business Name): NICHOLAS LEE GRIFFIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 INDEPENDENCE RD
CANON CITY CO
81212-9380
US

IV. Provider business mailing address

111 VESTA RD
SALIDA CO
81201-9327
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-2351
  • Fax:
Mailing address:
  • Phone: 719-539-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0022333
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: