Provider Demographics
NPI:1093166936
Name:SAFFORD, NICOLE V
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:V
Last Name:SAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:V
Other - Last Name:FRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8360 POLLENZO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6567
Mailing Address - Country:US
Mailing Address - Phone:702-337-3111
Mailing Address - Fax:702-242-5242
Practice Address - Street 1:8360 POLLENZO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-6567
Practice Address - Country:US
Practice Address - Phone:702-337-3111
Practice Address - Fax:702-552-8861
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4172106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner