Healthcare Provider Details

I. General information

NPI: 1386132017
Provider Name (Legal Business Name): NICOLE SIDEBOTTOM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 VILLAGE SQUARE DR STE 207
CASTLE PINES CO
80108-3693
US

IV. Provider business mailing address

7505 VILLAGE SQUARE DR STE 207
CASTLE PINES CO
80108-3693
US

V. Phone/Fax

Practice location:
  • Phone: 303-323-4722
  • Fax:
Mailing address:
  • Phone: 303-323-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6381
License Number StateCO

VIII. Authorized Official

Name: NICOLE SIDEBOTTOM
Title or Position: OWNER
Credential: MA LPC
Phone: 303-323-4722