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NPI Code Detail

MEDICARE: MR. BRUCE EDWARD NICELY NCSP

MEDICARE:  MR. BRUCE EDWARD NICELY  NCSP
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
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1417015298
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE EDWARD NICELY NCSP
Provider Business Mailing Address
First Line : 6949 COOK RD
Second Line :
City : POWELL
State : OH
Zip : 43065-8970
Country : US
Telephone Number : 614-365-5220
Fax Number :
Provider Business Practice Location Address
First Line : 737 E HUDSON ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43211-1034
Country : US
Telephone Number : 614-365-5220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 08/08/2014

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