Provider Demographics
NPI:1508544495
Name:NICHOLSON, STACEY DANIELLE (LCMFT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DANIELLE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 INDIAN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1429
Mailing Address - Country:US
Mailing Address - Phone:937-418-6280
Mailing Address - Fax:
Practice Address - Street 1:16500 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1429
Practice Address - Country:US
Practice Address - Phone:937-418-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist