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General NPI Number Information
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NPI Number | 1083527360
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Entity Type | Organization
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Legal Business Name | SHELLY NICOL, PSYD LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 4631 SE 62ND AVE
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City | PORTLAND
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State | OR
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Zip | 97206-4603
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Country | US
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Telephone | 808-381-5834
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE A
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City | PORTLAND
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State | OR
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Zip | 97239-3822
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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 | PSYCHOLOGIST
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Name | SHELLY NICOL
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Credential | PSYD
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Telephone | 808-381-5834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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