Provider Demographics
NPI:1326262346
Name:PATEL, NIMISHA (LCSW,LD)
Entity Type:Individual
Prefix:
First Name:NIMISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LCSW,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2947
Mailing Address - Country:US
Mailing Address - Phone:469-854-1656
Mailing Address - Fax:
Practice Address - Street 1:1514 N GREENVILLE AVE STE 310
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1205
Practice Address - Country:US
Practice Address - Phone:469-854-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX427281041C0700X
TXDT80265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered