Provider Demographics
NPI:1083863930
Name:NICKEL, JAY B (LPC-S)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:NICKEL
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8956 RESEARCH BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5902
Mailing Address - Country:US
Mailing Address - Phone:512-451-7337
Mailing Address - Fax:512-451-8729
Practice Address - Street 1:282 OLD KYLE RD
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-9701
Practice Address - Country:US
Practice Address - Phone:512-663-5941
Practice Address - Fax:575-448-7404
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
TX61764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral