Healthcare Provider Details

I. General information

NPI: 1154101483
Provider Name (Legal Business Name): JON NICHOLS APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 GEER RD STE 107
TURLOCK CA
95380-3269
US

IV. Provider business mailing address

162 BENJAMIN WAY
TURLOCK CA
95380-4465
US

V. Phone/Fax

Practice location:
  • Phone: 209-427-5610
  • Fax:
Mailing address:
  • Phone: 209-620-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: