Provider Demographics
NPI:1477219152
Name:FALCON, NICHOLAS EMMANUEL (PLMHP, TLMHC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EMMANUEL
Last Name:FALCON
Suffix:
Gender:M
Credentials:PLMHP, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 MAYFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4703
Mailing Address - Country:US
Mailing Address - Phone:402-575-0365
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9028
Practice Address - Country:US
Practice Address - Phone:712-256-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health