Provider Demographics
NPI:1275316382
Name:HOWARD, NICHOLAS JUSTIN
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JUSTIN
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S PATERSON ST STE 370
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4501
Mailing Address - Country:US
Mailing Address - Phone:608-445-6998
Mailing Address - Fax:
Practice Address - Street 1:211 S PATERSON ST STE 370
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4501
Practice Address - Country:US
Practice Address - Phone:608-535-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1061-228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health