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General NPI Number Information
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NPI Number | 1043819915
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Entity Type | Individual
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Provider Name | TAMMI R NICHOLSON LMHCA
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 488 W HOSPITAL RD
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City | PAOLI
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State | IN
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Zip | 47454-8807
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Country | US
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Telephone | 812-723-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 OLD STATE ROAD 60 E
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City | SALEM
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State | IN
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Zip | 47167-9703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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