MEDICARE: MRS. NICOLE BRIGHTON MA, TLMFT

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	106H00000X	Marriage & Family Therapist	075213	IA

General Provider Information

NPI Number	:	1124419197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE BRIGHTON MA, TLMFT

Provider Business Mailing Address
First Line	:	628 KNOLL ST SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3138
Country	:	US
Telephone Number	:	319-360-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 E AVE NW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52405-2962
Country	:	US
Telephone Number	:	800-531-4236
Fax Number	:	319-483-6661

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

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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