Healthcare Provider Details

I. General information

NPI: 1649347758
Provider Name (Legal Business Name): EMMA D NICHOLLS PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 E INDIANA ST STE 103
EVANSVILLE IN
47715-2794
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 812-401-8008
  • Fax: 812-401-8201
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-473-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041775
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: