Provider Demographics
NPI:1164922159
Name:ROBIN L. NICHOLS, LMFT
Entity Type:Organization
Organization Name:ROBIN L. NICHOLS, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-364-4838
Mailing Address - Street 1:3410 LA SIERRA AVE # F-156
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5270
Mailing Address - Country:US
Mailing Address - Phone:951-364-4838
Mailing Address - Fax:
Practice Address - Street 1:5053 LA MART DR STE 207
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5990
Practice Address - Country:US
Practice Address - Phone:951-364-4838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty