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General NPI Number Information
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NPI Number | 1629898812
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Entity Type | Individual
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Provider Name | NICHOLAS RADACH
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Gender | Male
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 7175 W JEFFERSON AVE STE 2800
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City | LAKEWOOD
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State | CO
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Zip | 80235-2319
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Country | US
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Telephone | 720-627-7734
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Fax | 303-265-9247
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Provider Business Mailing Address
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Address Line | 8461 TURNPIKE DR STE 203
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City | WESTMINSTER
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State | CO
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Zip | 80031-4379
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Country | US
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Telephone | 720-627-7734
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Fax | 303-265-9247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0021341
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License Number State | CO
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