Provider Demographics
NPI:1235631268
Name:NICKLAS, ANNE LINDSEY (LMHC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LINDSEY
Last Name:NICKLAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 STATE HIGHWAY 166
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-4606
Mailing Address - Country:US
Mailing Address - Phone:607-282-6978
Mailing Address - Fax:
Practice Address - Street 1:29 PIONEER ST
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1050
Practice Address - Country:US
Practice Address - Phone:607-282-6978
Practice Address - Fax:607-891-3561
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO9691101YM0800X
NY009794-01101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health