Healthcare Provider Details

I. General information

NPI: 1225418155
Provider Name (Legal Business Name): RICHARD NIKLA LMHC DBA WEST COAST BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CONSTITUTION BLVD
SARASOTA FL
34231-4146
US

IV. Provider business mailing address

5441 RIVERBLUFF CIR # V85
SARASOTA FL
34231-5025
US

V. Phone/Fax

Practice location:
  • Phone: 941-780-6939
  • Fax: 941-953-1399
Mailing address:
  • Phone: 941-780-6939
  • Fax: 941-953-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD HARBESON NIKLA
Title or Position: OWNER
Credential: MA, LMHC, CAP, ICADC
Phone: 941-780-6939