Provider Demographics
NPI:1558918250
Name:HERZOG, NICHOLAS BAER
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BAER
Last Name:HERZOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 S ROSLYN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2123
Mailing Address - Country:US
Mailing Address - Phone:503-352-7333
Mailing Address - Fax:
Practice Address - Street 1:5350 S ROSLYN ST STE 240
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2123
Practice Address - Country:US
Practice Address - Phone:303-351-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health