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General NPI Number Information
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NPI Number | 1427661164
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Entity Type | Organization
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Legal Business Name | NICHOLAS BOEDER - LCSW
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 3921 BINGHAM HILL RD
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City | FORT COLLINS
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State | CO
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Zip | 80521-1025
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Country | US
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Telephone | 575-770-0436
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 473
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City | LYONS
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State | CO
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Zip | 80540-0473
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Country | US
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Telephone | 575-770-0436
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | NICHOLAS BOEDER
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Credential | LCSW
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Telephone | 575-770-0436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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