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General NPI Number Information
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NPI Number | 1497802995
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Entity Type | Individual
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Provider Name | CAROLYN J. NICHOLS LPC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1736 E SUNSHINE ST PLAZA TOWERS-SUITE 508
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City | SPRINGFIELD
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State | MO
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Zip | 65804-1343
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Country | US
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Telephone | 417-766-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 E BITTERSWEET WAY
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City | SPRINGFIELD
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State | MO
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Zip | 65809-2403
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Country | US
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Telephone | 417-887-7803
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002622
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License Number State | MO
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