Healthcare Provider Details

I. General information

NPI: 1396663654
Provider Name (Legal Business Name): JOHRIE LEE ROSE NICHOLSON LMSW- CSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

IV. Provider business mailing address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

V. Phone/Fax

Practice location:
  • Phone: 702-451-2141
  • Fax:
Mailing address:
  • Phone: 702-451-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIC-3026
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: