Healthcare Provider Details

I. General information

NPI: 1316463789
Provider Name (Legal Business Name): STEVEN D NICHOLS PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LINWOOD AVE STE 2
CINCINNATI OH
45226-1274
US

IV. Provider business mailing address

3200 LINWOOD AVE STE 2
CINCINNATI OH
45226-1274
US

V. Phone/Fax

Practice location:
  • Phone: 513-312-2203
  • Fax: 513-672-9277
Mailing address:
  • Phone: 513-312-2203
  • Fax: 513-672-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN D NICHOLS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 513-312-2203