Healthcare Provider Details

I. General information

NPI: 1760825723
Provider Name (Legal Business Name): SCOTT N. NICHOLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 HARRISON AVE
CINCINNATI OH
45247-7957
US

IV. Provider business mailing address

6460 HARRISON AVE STE 200
CINCINNATI OH
45247-7958
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax: 513-694-0168
Mailing address:
  • Phone: 513-941-4999
  • Fax: 513-694-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161695
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: