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General NPI Number Information
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NPI Number | 1164868733
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Entity Type | Individual
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Provider Name | ROBIN L NICHOLS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 49500 TWIN PINES RD
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City | BANNING
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State | CA
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Zip | 92220-9681
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Country | US
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Telephone | 951-849-8416
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 LA SIERRA AVE # F156
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City | RIVERSIDE
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State | CA
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Zip | 92503-5270
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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