Provider Demographics
NPI:1245393826
Name:NICHOLS, JUNE A (PSYD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4138
Mailing Address - Country:US
Mailing Address - Phone:256-543-1544
Mailing Address - Fax:256-543-1508
Practice Address - Street 1:715 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4138
Practice Address - Country:US
Practice Address - Phone:256-543-1544
Practice Address - Fax:256-543-1508
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL762103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR60592Medicare UPIN