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General NPI Number Information
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NPI Number | 1346125408
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Entity Type | Individual
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Provider Name | JAZMIN NICHOLS
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Gender |
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 103 E MAIN ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-1900
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Country | US
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Telephone | 509-301-3270
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 HAVERWOOD PARK
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City | LEXINGTON
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State | KY
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Zip | 40514-1834
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Country | US
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Telephone | 502-536-6108
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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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