Healthcare Provider Details

I. General information

NPI: 1750162723
Provider Name (Legal Business Name): ASHELY NICHOLE NIESER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MCCARTY LN STE 1
JACKSON OH
45640-7025
US

IV. Provider business mailing address

502 MCCARTY LN STE 1
JACKSON OH
45640-7025
US

V. Phone/Fax

Practice location:
  • Phone: 740-577-9003
  • Fax: 740-577-9194
Mailing address:
  • Phone: 740-577-9003
  • Fax: 740-577-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: