Provider Demographics
NPI:1174279160
Name:HUMES, NICHOLE E (LMFT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:E
Last Name:HUMES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:HUMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2206 SE 72ND AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4048
Mailing Address - Country:US
Mailing Address - Phone:415-621-9349
Mailing Address - Fax:
Practice Address - Street 1:2206 SE 72ND AVE
Practice Address - Street 2:UNIT B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215
Practice Address - Country:US
Practice Address - Phone:415-621-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121954106H00000X
ORT1802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist