MEDICARE: PATRICIA A NICHOLS LCPC

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	1178 LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000742280	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1063557296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A NICHOLS LCPC

Provider Business Mailing Address
First Line	:	1643 24TH ST W
Second Line	:	SUITE 108
City	:	BILLINGS
State	:	MT
Zip	:	59102-2677
Country	:	US
Telephone Number	:	406-670-3956
Fax Number	:	406-294-0967

Provider Business Practice Location Address
First Line	:	1643 24TH ST W
Second Line	:	SUITE 108
City	:	BILLINGS
State	:	MT
Zip	:	59102-2677
Country	:	US
Telephone Number	:	406-670-3956
Fax Number	:	406-294-0967

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/13/2009

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