Provider Demographics
NPI:1477333235
Name:NICHOLSON, JULIE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LPC
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 322
Mailing Address - Street 2:
Mailing Address - City:CONCHO
Mailing Address - State:AZ
Mailing Address - Zip Code:85924-0322
Mailing Address - Country:US
Mailing Address - Phone:928-386-9237
Mailing Address - Fax:
Practice Address - Street 1:30 CO RD 3398
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AZ
Practice Address - Zip Code:85940
Practice Address - Country:US
Practice Address - Phone:928-251-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health