Healthcare Provider Details

I. General information

NPI: 1306550173
Provider Name (Legal Business Name): NICHOLE MICHELLE MARTIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICHOLE MICHELLE CRAWFORD LMHC

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 73RD ST STE D
WINDSOR HEIGHTS IA
50324-1339
US

IV. Provider business mailing address

1239 73RD ST STE D
WINDSOR HEIGHTS IA
50324-1339
US

V. Phone/Fax

Practice location:
  • Phone: 515-559-7546
  • Fax:
Mailing address:
  • Phone: 515-559-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116774
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: