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General NPI Number Information
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NPI Number | 1871995522
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Entity Type | Individual
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Provider Name | SCHELLY NICHOLS
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1100 CORPORATE OFFICE DR STE 300
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City | MILFORD
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State | MI
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Zip | 48381-5002
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Country | US
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Telephone | 248-714-9289
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Fax | 734-780-3005
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Provider Business Mailing Address
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Address Line | 26683 DALE ST
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City | ROSEVILLE
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State | MI
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Zip | 48066-3113
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Country | US
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Telephone | 313-255-0900
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802088124
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801115471
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License Number State | MI
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