Healthcare Provider Details

I. General information

NPI: 1609248848
Provider Name (Legal Business Name): NIKITA EHLTS LMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 31ST ST NE STE C
CEDAR RAPIDS IA
52402-4056
US

IV. Provider business mailing address

1435 31ST ST NE STE C
CEDAR RAPIDS IA
52402-4056
US

V. Phone/Fax

Practice location:
  • Phone: 319-448-3481
  • Fax:
Mailing address:
  • Phone: 319-448-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2014041465
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number088381
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0410776
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1609248848
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: