MEDICARE: MS. ROSEMARY B NICHOLS MSN, PMH/CNS, LMFT

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	1628	TX
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	414379	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	2292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000076B	OTHER	TX	BLUECROSS/BLUESHIELD
2	752363246	OTHER	TX	CIGNAHEALTHCARE
3	9218638	OTHER	TX	PRIVATEHEALTHCARESYSTEMS
4	226945	OTHER	TX	MANAGEDHEALTHNETWORK
5	752363246	OTHER	TX	CIGNABEHAVIORALHEALTH
6	0050245	OTHER	TX	BLUECROSSBLUESHIELDBLUE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	116176523	OTHER	TX	UNITEDBEHAVIORALHEALTH

General Provider Information

NPI Number	:	1336134410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSEMARY B NICHOLS MSN, PMH/CNS, LMFT

Provider Business Mailing Address
First Line	:	12247 RIDGEFAIR PL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7805
Country	:	US
Telephone Number	:	972-241-8697
Fax Number	:	972-241-8697

Provider Business Practice Location Address
First Line	:	12247 RIDGEFAIR PL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7805
Country	:	US
Telephone Number	:	972-241-8697
Fax Number	:	972-241-8697

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/15/2026

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