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General NPI Number Information
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NPI Number | 1063896553
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Entity Type | Individual
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Provider Name | STEPHANIE JEAN MCNICHOLS MA, PLMHP, PLDAC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 770 N COTNER BLVD STE 116
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City | LINCOLN
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State | NE
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Zip | 68505-2344
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Country | US
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Telephone | 402-236-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 WOODSDALE BLVD
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City | LINCOLN
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State | NE
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Zip | 68502-5044
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Country | US
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Telephone | 402-440-6496
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | P-1318
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1345
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10548
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2368
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License Number State | NE
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