Provider Demographics
NPI:1508397308
Name:HAL NICHOLS ASSOCIATES LLC
Entity Type:Organization
Organization Name:HAL NICHOLS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCSW, LCAC
Authorized Official - Phone:913-648-6940
Mailing Address - Street 1:11100 ASH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1925
Mailing Address - Country:US
Mailing Address - Phone:913-648-6940
Mailing Address - Fax:877-329-8382
Practice Address - Street 1:11100 ASH ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1804
Practice Address - Country:US
Practice Address - Phone:913-648-6940
Practice Address - Fax:877-329-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07310947252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201128190AMedicaid