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NPI Code Detail

MEDICARE: MR. PATRICK NICHOLSON

MEDICARE:  MR. PATRICK  NICHOLSON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1477645406
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PATRICK NICHOLSON
Provider Business Mailing Address
First Line : 2090 RIVER AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-3621
Country : US
Telephone Number : 562-826-8480
Fax Number :
Provider Business Practice Location Address
First Line : 2090 RIVER AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90810-3621
Country : US
Telephone Number : 562-826-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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Directions to “ MR. PATRICK NICHOLSON ” Practice Location

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