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General NPI Number Information
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NPI Number | 1497164347
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Entity Type | Individual
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Provider Name | ADAM L NICKELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 3270 E 17TH ST # 131
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City | AMMON
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State | ID
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Zip | 83406-6758
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Country | US
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Telephone | 208-534-6568
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Fax |
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Provider Business Mailing Address
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Address Line | 3270 E 17TH ST # 131
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City | AMMON
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State | ID
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Zip | 83406-6758
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Country | US
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Telephone | 208-534-6568
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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 | 14206814-3501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW- 36181
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License Number State | ID
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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 | LCSW-36181
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14206814-3501
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License Number State | UT
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