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General NPI Number Information
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NPI Number | 1033029491
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Entity Type | Organization
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Legal Business Name | DR NICOLES ONLINE THERAPY, INC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 2208 SKYLINE DR
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City | WEST BEND
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State | WI
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Zip | 53090-1143
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Country | US
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Telephone | 414-232-7277
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 434
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City | SLINGER
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State | WI
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Zip | 53086-0434
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Country | US
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Telephone | 414-232-7277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICOLE SMITH
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Credential | PSYD
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Telephone | 414-232-7277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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