Healthcare Provider Details

I. General information

NPI: 1629768627
Provider Name (Legal Business Name): NICHOLE CHRISTINE MOURIZ LCSW 139605
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45111 FERN AVE
LANCASTER CA
93534-2301
US

IV. Provider business mailing address

2010 W AVENUE K # 1111
LANCASTER CA
93536-5229
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-1206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: