Provider Demographics
NPI:1275304354
Name:NEXTGEN BEHAVIORAL THERAPY, PLLC
Entity Type:Organization
Organization Name:NEXTGEN BEHAVIORAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KORELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHCA
Authorized Official - Phone:984-837-7944
Mailing Address - Street 1:6527 TREMOLO TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1996
Mailing Address - Country:US
Mailing Address - Phone:406-868-9128
Mailing Address - Fax:
Practice Address - Street 1:3435 KILDAIRE FARM RD STE 534
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1545
Practice Address - Country:US
Practice Address - Phone:984-837-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty