Provider Demographics
NPI:1114349321
Name:NICKOLAUS, BROOKE NICOLE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:NICKOLAUS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:FLODIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:90990 SUMMIT VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-551-7914
Mailing Address - Fax:509-627-2060
Practice Address - Street 1:1950-O KEENE ROAD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-627-2600
Practice Address - Fax:509-627-2060
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WALH60574006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health