Healthcare Provider Details

I. General information

NPI: 1992457188
Provider Name (Legal Business Name): JUSTIN NGUYEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 FELKINS ST BLDG 1226
FORT CARSON CO
80913
US

IV. Provider business mailing address

6541 SPECKER AVE BLDG 1830
FORT CARSON CO
80913-4263
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-7705
  • Fax:
Mailing address:
  • Phone: 719-503-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: