MEDICARE: SCOTT NICHOLS LCSW

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	34004871A	IN
2	1041C0700X	Clinical Social Worker	34004871A	IN

General Provider Information

NPI Number	:	1891761771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT NICHOLS LCSW

Provider Business Mailing Address
First Line	:	8122 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-884-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	8122 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-884-1752
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	09/16/2014

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Directions to “ SCOTT NICHOLS LCSW” Practice Location

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