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General NPI Number Information
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NPI Number | 1598280224
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Entity Type | Individual
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Provider Name | ELLEN ELIZABETH NICHOLS PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 360 MOBIL AVE STE K
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City | CAMARILLO
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State | CA
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Zip | 93010-6325
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Country | US
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Telephone | 818-584-4728
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Fax | 818-706-8684
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Provider Business Mailing Address
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Address Line | 1860 FALLING STAR AVE
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-5277
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Country | US
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Telephone | 818-522-3810
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Fax | 818-706-8684
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94022807
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License Number State | CA
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