Healthcare Provider Details

I. General information

NPI: 1275969362
Provider Name (Legal Business Name): NICOLE HELENA CHOW PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 OAK GLN
IRVINE CA
92618-4708
US

IV. Provider business mailing address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

V. Phone/Fax

Practice location:
  • Phone: 949-529-0565
  • Fax:
Mailing address:
  • Phone: 310-531-3111
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY3128-
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: