Provider Demographics
NPI:1235789959
Name:NICHOLS, MARY ALVIN (MS ED)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALVIN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ALTA PINE DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1408
Mailing Address - Country:US
Mailing Address - Phone:310-991-3727
Mailing Address - Fax:
Practice Address - Street 1:1605 HOPE ST STE 210
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2670
Practice Address - Country:US
Practice Address - Phone:310-991-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist