Healthcare Provider Details

I. General information

NPI: 1548024003
Provider Name (Legal Business Name): LINDSAY NICHOLS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH HWY 89 BUILDING 161 ROOM 227
PRESCOTT AZ
86313
US

IV. Provider business mailing address

500 NORTH HWY 89 BUILDING 161 ROOM 227
PRESCOTT AZ
86313
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-22007
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: