MEDICARE: SAMUEL NICHOLS

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	:	1598041915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL NICHOLS

Provider Business Mailing Address
First Line	:	8141 CARL DEAN ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-7433
Country	:	US
Telephone Number	:	850-476-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	8141 CARL DEAN ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-7433
Country	:	US
Telephone Number	:	850-476-6688
Fax Number	:

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	11/05/2014

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Directions to “ SAMUEL NICHOLS ” Practice Location

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