Provider Demographics
NPI:1225310535
Name:BELL, NICHOLAS DUDLEY (MDIV, MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DUDLEY
Last Name:BELL
Suffix:
Gender:M
Credentials:MDIV, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9754
Mailing Address - Country:US
Mailing Address - Phone:815-645-2438
Mailing Address - Fax:
Practice Address - Street 1:3293 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:STILLMAN VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61084-9754
Practice Address - Country:US
Practice Address - Phone:815-645-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist