MEDICARE: WESLEY NICHOLLS LMHC

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
1	101YM0800X	Mental Health Counselor	LMHC10005561	MA

General Provider Information

NPI Number	:	1043173859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY NICHOLLS LMHC

Provider Business Mailing Address
First Line	:	433 S MAIN ST UNIT 2
Second Line	:
City	:	ATTLEBORO
State	:	MA
Zip	:	02703-6439
Country	:	US
Telephone Number	:	508-463-8611
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 DERBY ST STE 21
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4052
Country	:	US
Telephone Number	:	781-424-8119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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