Provider Demographics
NPI:1497263065
Name:KHOURY, NICHOLAS (LPC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KHOURY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3148 SERENITY CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2733
Mailing Address - Country:US
Mailing Address - Phone:248-635-0231
Mailing Address - Fax:
Practice Address - Street 1:8062 ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4456
Practice Address - Country:US
Practice Address - Phone:248-625-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health