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NPI Code Detail

MEDICARE: DAVID LEROY NICHOLSON-KLINGERMAN SR. MA LPC, LMHC, CMHS

MEDICARE: DAVID LEROY NICHOLSON-KLINGERMAN SR. MA LPC, LMHC, CMHS
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
1101YM0800XMental Health CounselorLH60571247WA
2101YP2500XProfessional CounselorC3354OR

General Provider Information

NPI Number : 1598823072
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID LEROY NICHOLSON-KLINGERMAN SR. MA LPC, LMHC, CMHS
Provider Business Mailing Address
First Line : 2204 PACIFIC AVE N
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3300
Country : US
Telephone Number : 360-642-3787
Fax Number :
Provider Business Practice Location Address
First Line : 2204 PACIFIC AVE N
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3300
Country : US
Telephone Number : 360-642-3787
Fax Number : 360-642-2096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 06/08/2021

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Directions to “ DAVID LEROY NICHOLSON-KLINGERMAN SR. MA LPC, LMHC, CMHS” Practice Location

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