MEDICARE: NICOLE BEIGHLE LSCSW, LISW

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
2	1041C0700X	Clinical Social Worker	I.2002434	OH
3	1041C0700X	Clinical Social Worker	LSCSW05912	KS

General Provider Information

NPI Number	:	1962981456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BEIGHLE LSCSW, LISW

Provider Business Mailing Address
First Line	:	PO BOX 144
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66505-0144
Country	:	US
Telephone Number	:	785-553-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 S 4TH ST STE 204
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-6957
Country	:	US
Telephone Number	:	785-553-9110
Fax Number	:	785-553-9116

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

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	06/15/2024

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