Healthcare Provider Details

I. General information

NPI: 1649847971
Provider Name (Legal Business Name): NICOLE DAGLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 NEW TRAILS DR STE 185
THE WOODLANDS TX
77381-4272
US

IV. Provider business mailing address

14930 MUESCHKE RD STE 100
CYPRESS TX
77433-0980
US

V. Phone/Fax

Practice location:
  • Phone: 346-206-3992
  • Fax: 832-652-3626
Mailing address:
  • Phone: 346-206-3992
  • Fax: 832-652-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111681-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: