MEDICARE: ANDREW NICHOLS 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	101Y00000X	Counselor	MC60421255	WA

General Provider Information

NPI Number	:	1467828020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW NICHOLS LMHC

Provider Business Mailing Address
First Line	:	1605 12TH AVE
Second Line	:	SUITE 27
City	:	SEATTLE
State	:	WA
Zip	:	98122-2467
Country	:	US
Telephone Number	:	206-569-4493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 12TH AVE
Second Line	:	SUITE 27
City	:	SEATTLE
State	:	WA
Zip	:	98122-2467
Country	:	US
Telephone Number	:	206-569-4493
Fax Number	:

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

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	03/07/2016

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