Provider Demographics
NPI:1346843638
Name:NICHOLS, BRANDI (LMFT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CENTER DR # 105-7037
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3500
Mailing Address - Country:US
Mailing Address - Phone:619-858-3105
Mailing Address - Fax:310-388-4948
Practice Address - Street 1:12396 WORLD TRADE DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3789
Practice Address - Country:US
Practice Address - Phone:619-858-3105
Practice Address - Fax:619-280-5420
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist