Healthcare Provider Details

I. General information

NPI: 1033762091
Provider Name (Legal Business Name): RIKKI CLOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 09/25/2022
Certification Date: 09/25/2022
Deactivation Date: 03/29/2022
Reactivation Date: 07/11/2022

III. Provider practice location address

2770 ARAPAHOE RD STE 132
LAFAYETTE CO
80026-8016
US

IV. Provider business mailing address

2770 ARAPAHOE ROAD STE 132 - MAILBOX 700
LAFAYETTE CO
80026-8016
US

V. Phone/Fax

Practice location:
  • Phone: 720-580-0393
  • Fax:
Mailing address:
  • Phone: 720-580-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCSW.09927791
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: