MEDICARE: JESSE MARIE NUCKOLS

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	101Y00000X	Counselor	LPCC.0024397	CO

General Provider Information

NPI Number	:	1205776234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE MARIE NUCKOLS

Provider Business Mailing Address
First Line	:	4112 GREEN RIDGE DR
Second Line	:
City	:	LAPORTE
State	:	CO
Zip	:	80535-9352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 ALPINE PLZ
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-2111
Country	:	US
Telephone Number	:	844-955-1066
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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