Provider Demographics
NPI:1124419197
Name:BRIGHTON, NICOLE (MA, TLMFT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:BRIGHTON
Suffix:
Gender:F
Credentials:MA, TLMFT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:STOVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:628 KNOLL ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3138
Mailing Address - Country:US
Mailing Address - Phone:319-360-6191
Mailing Address - Fax:
Practice Address - Street 1:3100 E AVE NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2962
Practice Address - Country:US
Practice Address - Phone:800-531-4236
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist