Healthcare Provider Details

I. General information

NPI: 1720936214
Provider Name (Legal Business Name): NICOLE ROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 PARK MEADOWS DR STE 100
LONE TREE CO
80124-5528
US

IV. Provider business mailing address

4188 WINONA CT
DENVER CO
80212-2257
US

V. Phone/Fax

Practice location:
  • Phone: 720-707-6914
  • Fax:
Mailing address:
  • Phone: 314-471-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0022344
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: