Healthcare Provider Details

I. General information

NPI: 1972384246
Provider Name (Legal Business Name): STEPHANIE NICKEL LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S GRAND MESA DR
CEDAREDGE CO
81413
US

IV. Provider business mailing address

21180 SURFACE CREEK RD
CEDAREDGE CO
81413-8131
US

V. Phone/Fax

Practice location:
  • Phone: 970-546-0108
  • Fax: 970-546-0109
Mailing address:
  • Phone: 970-546-0108
  • Fax: 970-546-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LYNN NICKEL
Title or Position: LPC
Credential:
Phone: 970-270-0527