Provider Demographics
NPI:1336134410
Name:NICHOLS, ROSEMARY B (MSN, PMH/CNS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:B
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSN, PMH/CNS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12247 RIDGEFAIR PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7805
Mailing Address - Country:US
Mailing Address - Phone:972-241-8697
Mailing Address - Fax:972-241-8697
Practice Address - Street 1:12247 RIDGEFAIR PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7805
Practice Address - Country:US
Practice Address - Phone:972-241-8697
Practice Address - Fax:972-241-8697
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1628106H00000X
TX414379364SP0808X
TX2292101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000076BOtherBLUECROSS/BLUESHIELD
TX752363246OtherCIGNAHEALTHCARE
TX9218638OtherPRIVATEHEALTHCARESYSTEMS
TX226945OtherMANAGEDHEALTHNETWORK
TX752363246OtherCIGNABEHAVIORALHEALTH
TX0050245OtherBLUECROSSBLUESHIELDBLUE
TX062536001Medicaid
TX116176523OtherUNITEDBEHAVIORALHEALTH