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NPI Code Detail

MEDICARE: GINA GINETTE NICHOLS LPCC

MEDICARE: GINA GINETTE NICHOLS LPCC
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
1101YP2500XProfessional Counselor103574KY

General Provider Information

NPI Number : 1790296788
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA GINETTE NICHOLS LPCC
Provider Business Mailing Address
First Line : 1712 HIGHWAY 121 BYP N STE I
Second Line :
City : MURRAY
State : KY
Zip : 42071-8864
Country : US
Telephone Number : 270-761-5804
Fax Number : 270-761-5807
Provider Business Practice Location Address
First Line : 1712 HIGHWAY 121 BYP N STE I
Second Line :
City : MURRAY
State : KY
Zip : 42071-8864
Country : US
Telephone Number : 270-761-5804
Fax Number : 270-761-5807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2017
Last Update Date : 10/17/2017

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Directions to “ GINA GINETTE NICHOLS LPCC” Practice Location

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