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General NPI Number Information
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NPI Number | 1609548585
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Entity Type | Individual
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Provider Name | YARLIE RUTH NICOLAS PHD, LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 6413 NW 72ND AVE
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City | TAMARAC
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State | FL
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Zip | 33321-5518
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Country | US
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Telephone | 954-709-0916
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Fax |
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Provider Business Mailing Address
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Address Line | 7957 N UNIVERSITY DR # 1037
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City | PARKLAND
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State | FL
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Zip | 33067-2601
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Country | US
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Telephone | 954-709-0916
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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 | 4097
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License Number State | FL
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