Individual
MR. BLAKE BAKER NICHOLSON III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
928 12TH ST, GREELEY, CO 80631-4024
(970) 336-4910
(970) 336-5000
Mailing address
590 FAR VIEW LN, ESTES PARK, CO 80517-9049
(970) 577-0606
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
992906
CO
Other
Enumeration date
02/14/2006
Last updated
07/08/2007
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