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NPI Code Detail

MEDICARE: JANE LUANNE NICHOLS LCPC

MEDICARE: JANE LUANNE 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
1101YP2500XProfessional Counselor180008867IL
2101YM0800XMental Health Counselor180008867IL

General Provider Information

NPI Number : 1235495672
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE LUANNE NICHOLS LCPC
Provider Business Mailing Address
First Line : PO BOX 3988
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-3988
Country : US
Telephone Number : 618-457-5200
Fax Number :
Provider Business Practice Location Address
First Line : 405 W JACKSON ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1462
Country : US
Telephone Number : 618-549-0721
Fax Number : 618-457-0469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2012
Last Update Date : 01/16/2026

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