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NPI Code Detail

MEDICARE: REBECCA JO NICHOLSON MS, LPC

MEDICARE: REBECCA JO NICHOLSON MS, LPC
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
1101YP2500XProfessional Counselor2011008110MO
2101Y00000XCounselor201100811MO

General Provider Information

NPI Number : 1073888392
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA JO NICHOLSON MS, LPC
Provider Business Mailing Address
First Line : 603B DAVID DR
Second Line :
City : MOUNTAIN VIEW
State : MO
Zip : 65548-8207
Country : US
Telephone Number : 417-372-4660
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N KENTUCKY AVE
Second Line :
City : WEST PLAINS
State : MO
Zip : 65775-2029
Country : US
Telephone Number : 417-372-4660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2012
Last Update Date : 04/07/2026

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