Healthcare Provider Details

I. General information

NPI: 1972981207
Provider Name (Legal Business Name): NICHOLE MAXWELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 WRONDEL WAY STE 260
RENO NV
89502-3701
US

IV. Provider business mailing address

2470 WRONDEL WAY STE 260
RENO NV
89502-3701
US

V. Phone/Fax

Practice location:
  • Phone: 775-420-9926
  • Fax:
Mailing address:
  • Phone: 775-420-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5483
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: