Healthcare Provider Details

I. General information

NPI: 1457885154
Provider Name (Legal Business Name): NICHOLE THOMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4329 NAMBE CT
LAS CRUCES NM
88011-4290
US

IV. Provider business mailing address

4329 NAMBE CT
LAS CRUCES NM
88011-4290
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-1105
  • Fax: 575-524-4266
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0127
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: