Healthcare Provider Details

I. General information

NPI: 1073888392
Provider Name (Legal Business Name): REBECCA JO NICHOLSON MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

603B DAVID DR
MOUNTAIN VIEW MO
65548-8207
US

V. Phone/Fax

Practice location:
  • Phone: 417-372-4660
  • Fax:
Mailing address:
  • Phone: 417-372-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011008110
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number201100811
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: