Healthcare Provider Details

I. General information

NPI: 1831693712
Provider Name (Legal Business Name): MR. NICHOLAS WILLIAM REICHERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 S LIBERTY ST
POWELL OH
43065-7619
US

IV. Provider business mailing address

169 S LIBERTY ST
POWELL OH
43065-7619
US

V. Phone/Fax

Practice location:
  • Phone: 614-506-9471
  • Fax:
Mailing address:
  • Phone: 614-506-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.1800766-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1800766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: