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General NPI Number Information
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NPI Number | 1922989821
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Entity Type | Individual
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Provider Name | JILL MICHELLE NICHOLS LMFT, MA, BS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1536 SUNRISE PLAZA DR STE 100
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City | CLERMONT
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State | FL
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Zip | 34714-6204
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Country | US
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Telephone | 407-488-4892
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Fax | 863-582-9993
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Provider Business Mailing Address
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Address Line | 1109 CYPRESS POINTE BLVD
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City | DAVENPORT
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State | FL
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Zip | 33896-3503
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Country | US
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Telephone | 402-227-5095
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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 | MT5308
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License Number State | FL
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