MEDICARE: MRS. NICHOLE MICHELLE MARTIN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	116774	IA

General Provider Information

NPI Number	:	1306550173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE MICHELLE MARTIN LMHC

Provider Business Mailing Address
First Line	:	1239 73RD ST STE D
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1339
Country	:	US
Telephone Number	:	515-559-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 73RD ST STE D
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1339
Country	:	US
Telephone Number	:	515-559-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	02/26/2026

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