Provider Demographics
NPI:1295407492
Name:NEWLAND, NICHOLAS LEE (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:NEWLAND
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E FERNHURST DR STE 1102
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1592
Mailing Address - Country:US
Mailing Address - Phone:281-940-8515
Mailing Address - Fax:
Practice Address - Street 1:633 E FERNHURST DR STE 1102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1592
Practice Address - Country:US
Practice Address - Phone:281-940-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health