Provider Demographics
NPI:1518116649
Name:MCCAULEY, NICOLE (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:110 W OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8713
Mailing Address - Country:US
Mailing Address - Phone:979-492-2795
Mailing Address - Fax:979-232-2135
Practice Address - Street 1:3212 E NETTLETON
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5451
Practice Address - Country:US
Practice Address - Phone:785-825-0541
Practice Address - Fax:785-825-0062
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AR2643-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid