Healthcare Provider Details

I. General information

NPI: 1093437220
Provider Name (Legal Business Name): COLTON JAMES VAUGHAN NISLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W M CT
LINCOLN NE
68522-1006
US

IV. Provider business mailing address

3515 E OVERLAND RD
MERIDIAN ID
83642-6757
US

V. Phone/Fax

Practice location:
  • Phone: 402-325-8555
  • Fax:
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: