Provider Demographics
NPI:1003950437
Name:NICHOLS, MARK ALAN (MED, MAC, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MED, MAC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 N. ORACLE RD, SUITE 312
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705
Mailing Address - Country:US
Mailing Address - Phone:520-544-0101
Mailing Address - Fax:520-293-3080
Practice Address - Street 1:4732 N. ORACLE RD, SUITE 312
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-544-0101
Practice Address - Fax:520-293-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional