Healthcare Provider Details

I. General information

NPI: 1972970515
Provider Name (Legal Business Name): NIKOLE RIOS LCPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKOLE JONES L.P.C.

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MCCLURE AVE
NAMPA ID
83651-2025
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-7654
  • Fax: 208-345-3502
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-466-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC-7024
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberLCPC-7024
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: