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NPI Code Detail

MEDICARE: NICOLE LATRECE NICHOLS LMHC

MEDICARE: NICOLE LATRECE NICHOLS LMHC
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
1101Y00000XCounselor
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548564883
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LATRECE NICHOLS LMHC
Provider Business Mailing Address
First Line : 4300 SW 13TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-4006
Country : US
Telephone Number : 352-374-5600
Fax Number : 352-374-5608
Provider Business Practice Location Address
First Line : 945 GRAND ST
Second Line :
City : STARKE
State : FL
Zip : 32091-1821
Country : US
Telephone Number : 352-374-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2010
Last Update Date : 12/14/2015

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Directions to “ NICOLE LATRECE NICHOLS LMHC” Practice Location

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