Provider Demographics
NPI:1487868477
Name:NICHOLS, BROOKE (LCPC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10336 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2290
Mailing Address - Country:US
Mailing Address - Phone:913-593-8989
Mailing Address - Fax:
Practice Address - Street 1:10336 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2290
Practice Address - Country:US
Practice Address - Phone:913-593-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS341101YM0800X
MO2006000743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487868477Medicaid