MEDICARE: STEVEN WOOD NICHOLAS MFT-I, NCC

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	R07028	NV

General Provider Information

NPI Number	:	1215137278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WOOD NICHOLAS MFT-I, NCC

Provider Business Mailing Address
First Line	:	5845 INGLESTON DR
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89436-5016
Country	:	US
Telephone Number	:	775-335-5746
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 W PLUMB LN # F
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-3766
Country	:	US
Telephone Number	:	775-335-5746
Fax Number	:

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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