MEDICARE: DARLENE ALLEN NICHOLS PHD

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	101YP1600X	Pastoral Counselor
2	101Y00000X	Counselor	178019560	IL

General Provider Information

NPI Number	:	1447999016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE ALLEN NICHOLS PHD

Provider Business Mailing Address
First Line	:	11848 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4734
Country	:	US
Telephone Number	:	773-366-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	11848 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4734
Country	:	US
Telephone Number	:	773-366-3437
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	12/05/2023

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