MEDICARE: MRS. NISHA PATEL LPC

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	LPC010410	GA

General Provider Information

NPI Number	:	1740757947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NISHA PATEL LPC

Provider Business Mailing Address
First Line	:	2801 BUFORD HWY NE STE 530
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2143
Country	:	US
Telephone Number	:	678-896-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE STE 530
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2143
Country	:	US
Telephone Number	:	404-721-0675
Fax Number	:

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

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	03/04/2024

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