MEDICARE: MRS. NICOLE WIRTH MS, LPC, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0017008	CO
2	101YM0800X	Mental Health Counselor	0017008	CO
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADC.0001899	CO

General Provider Information

NPI Number	:	1114439585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE WIRTH MS, LPC, LAC

Provider Business Mailing Address
First Line	:	3601 S BROADWAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3610
Country	:	US
Telephone Number	:	303-658-0059
Fax Number	:	303-800-9755

Provider Business Practice Location Address
First Line	:	3601 S BROADWAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3610
Country	:	US
Telephone Number	:	561-251-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	12/11/2025

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