Provider Demographics
NPI:1326346263
Name:NICHOLS, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-0080
Mailing Address - Country:US
Mailing Address - Phone:254-582-2642
Mailing Address - Fax:254-582-2642
Practice Address - Street 1:921 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2520
Practice Address - Country:US
Practice Address - Phone:254-582-2642
Practice Address - Fax:254-582-2642
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX403761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical