Provider Demographics
NPI:1508401787
Name:SCHWAN, NICOLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHWAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7588 CENTRAL PARKE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6857
Mailing Address - Country:US
Mailing Address - Phone:513-201-8818
Mailing Address - Fax:
Practice Address - Street 1:7588 CENTRAL PARKE BLVD STE 114
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6857
Practice Address - Country:US
Practice Address - Phone:513-201-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017007101YP2500X
OHC1902176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional