MR. Blake Baker Nicholson III, LCSW

NPI #1891769261 in Greeley, Colorado

Provider Information

NPI Number: 1891769261
Entity Type: Individual
Name: MR. Blake Baker Nicholson III, LCSW
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Social Worker - Clinical
Credential: LCSW
Enumeration Date: Feb 14, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 928 12TH ST
City: Greeley
State: Colorado
ZIP Code: 80631-4024
Phone: (970) 336-4910

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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