Provider Demographics
NPI:1053533992
Name:WARNYGORA, NICOLE RAY (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RAY
Last Name:WARNYGORA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 272673
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527
Mailing Address - Country:US
Mailing Address - Phone:970-222-8365
Mailing Address - Fax:
Practice Address - Street 1:123 N COLLEGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2489
Practice Address - Country:US
Practice Address - Phone:970-222-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304101YP2500X
CO3102103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist