Provider Demographics
NPI:1467042598
Name:BIVENS, NICHOLAS D
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:BIVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23303 FALL WIND CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2133
Mailing Address - Country:US
Mailing Address - Phone:713-208-0383
Mailing Address - Fax:
Practice Address - Street 1:9545 KATY FWY STE 425
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1471
Practice Address - Country:US
Practice Address - Phone:713-208-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)