Provider Demographics
NPI:1497802995
Name:NICHOLS, CAROLYN J (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:NICHOLS
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 1:4715 E BITTERSWEET WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2403
Mailing Address - Country:US
Mailing Address - Phone:417-887-7803
Mailing Address - Fax:
Practice Address - Street 1:1736 E SUNSHINE ST
Practice Address - Street 2:PLAZA TOWERS-SUITE 508
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1343
Practice Address - Country:US
Practice Address - Phone:417-766-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002622101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor