Provider Demographics
NPI:1104196369
Name:JULIA M NICKLE LMHC, INC
Entity Type:Organization
Organization Name:JULIA M NICKLE LMHC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:417-812-4866
Mailing Address - Street 1:PO BOX 11224
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-1224
Mailing Address - Country:US
Mailing Address - Phone:417-812-4866
Mailing Address - Fax:
Practice Address - Street 1:3997 COMMONS DR W
Practice Address - Street 2:STE C
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8443
Practice Address - Country:US
Practice Address - Phone:850-376-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty