Provider Demographics
NPI:1053554964
Name:MOORMAN, NICHOLE L (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:L
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 REDCLIFF CIR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9243
Mailing Address - Country:US
Mailing Address - Phone:970-318-0529
Mailing Address - Fax:
Practice Address - Street 1:380 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432
Practice Address - Country:US
Practice Address - Phone:970-318-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000015651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical