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NPI Code Detail

MEDICARE: MRS. JUNG M NICHOLS LMSW

MEDICARE: MRS. JUNG M NICHOLS LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801087873MI

General Provider Information

NPI Number : 1023268661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUNG M NICHOLS LMSW
Provider Business Mailing Address
First Line : 34515 HIVELEY ST
Second Line :
City : WESTLAND
State : MI
Zip : 48186-4322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 HAMLIN DR
Second Line :
City : INKSTER
State : MI
Zip : 48141-2348
Country : US
Telephone Number : 734-941-4991
Fax Number : 734-941-4919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2008
Last Update Date : 03/26/2013

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