Provider Demographics
NPI:1043101066
Name:DAVIS, NICHOLAS (LPC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 HAWTHORNE RD APT 15
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2261
Mailing Address - Country:US
Mailing Address - Phone:208-269-0601
Mailing Address - Fax:
Practice Address - Street 1:4737 S AFTON PL STE A
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2317
Practice Address - Country:US
Practice Address - Phone:208-417-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4671469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional