Healthcare Provider Details

I. General information

NPI: 1871438366
Provider Name (Legal Business Name): NICOLE CRADDOCK GULATI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605A W COLORADO AVE
COLORADO SPGS CO
80904-3034
US

IV. Provider business mailing address

PO BOX 6388
COLORADO SPRINGS CO
80934-6388
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-1352
  • Fax:
Mailing address:
  • Phone: 719-373-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0005210
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: