Provider Demographics
NPI:1003447236
Name:SALLEE, NICOLE LEONA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEONA
Last Name:SALLEE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5120
Mailing Address - Country:US
Mailing Address - Phone:682-239-9872
Mailing Address - Fax:
Practice Address - Street 1:201 MAIN ST FL 6
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3105
Practice Address - Country:US
Practice Address - Phone:817-339-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional