Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Blake Baker Nicholson III, LCSW

Individual provider Clinical Social Worker · NPI 1891769261

Mr. Blake Baker Nicholson III, LCSW is a Clinical Social Worker in Greeley, Colorado. Graduated from University of Kansas School of Med (KC/WICH/SAL) in 1998, 28 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Colorado.

Years since qualifying
28
Trained at
University of Kansas School of Med (KC/WICH/SAL)
Licensed in
CO
In the registry since
2006
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

928 12th St
Greeley, CO 80631-4024
Phone: (970) 336-4910
Fax: (970) 336-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 992906 (CO)

Record details

NPI number1891769261
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedFebruary 14, 2006
Last updated in NPPESJuly 13, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolUNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Graduated 1998 (28 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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