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NPI Code Detail

MEDICARE: MIKE NICHOLES LCSW

MEDICARE: MIKE NICHOLES LCSW
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 Worker125MT

General Provider Information

NPI Number : 1205879103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE NICHOLES LCSW
Provider Business Mailing Address
First Line : 2429 MISSION WAY
Second Line :
City : BILLINGS
State : MT
Zip : 59102-0161
Country : US
Telephone Number : 406-245-9949
Fax Number :
Provider Business Practice Location Address
First Line : 3940 RIMROCK RD
Second Line :
City : BILLINGS
State : MT
Zip : 59102-0141
Country : US
Telephone Number : 406-655-5600
Fax Number : 406-655-5656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 06/29/2015

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