MEDICARE: NICOLE GRICIUS LPC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467838755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GRICIUS LPC

Provider Business Mailing Address
First Line	:	593 NW YORK DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7264
Country	:	US
Telephone Number	:	541-224-8492
Fax Number	:

Provider Business Practice Location Address
First Line	:	593 NW YORK DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7264
Country	:	US
Telephone Number	:	541-224-8492
Fax Number	:

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

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	04/03/2020

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Directions to “ NICOLE GRICIUS LPC” Practice Location

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