Provider Demographics
NPI:1336667476
Name:NICOLET, NICHOLAS (LCMHC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:NICOLET
Suffix:
Gender:M
Credentials:LCMHC
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 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-1399
Mailing Address - Fax:802-223-8623
Practice Address - Street 1:174 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9105
Practice Address - Country:US
Practice Address - Phone:802-479-4083
Practice Address - Fax:802-476-1476
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0080943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health