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NPI Code Detail

MEDICARE: TERESA NICHOLSON LLBSW

MEDICARE: TERESA NICHOLSON LLBSW
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
2247200000XOther TechnicianMI

General Provider Information

NPI Number : 1528456134
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA NICHOLSON LLBSW
Provider Business Mailing Address
First Line : 6549 TOWN CENTER DR
Second Line :
City : CLARKSTON
State : MI
Zip : 48346-4824
Country : US
Telephone Number : 800-395-3223
Fax Number : 248-620-6405
Provider Business Practice Location Address
First Line : 13305 REECK CT
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-3197
Country : US
Telephone Number : 800-395-3223
Fax Number : 248-620-6405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 05/20/2025

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