Provider Demographics
NPI:1225882129
Name:NICHOLS-TAYLOR, ALETHEA
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:
Last Name:NICHOLS-TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-6979
Mailing Address - Country:US
Mailing Address - Phone:313-673-1273
Mailing Address - Fax:
Practice Address - Street 1:2971 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-6979
Practice Address - Country:US
Practice Address - Phone:989-341-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17963101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor