Provider Demographics
NPI:1528595741
Name:FOSS, NICOLAS (MS, IADC, NCGC-II)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:FOSS
Suffix:
Gender:M
Credentials:MS, IADC, NCGC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2623
Mailing Address - Country:US
Mailing Address - Phone:319-753-6567
Mailing Address - Fax:319-753-0703
Practice Address - Street 1:1340 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2623
Practice Address - Country:US
Practice Address - Phone:319-753-6567
Practice Address - Fax:319-753-0703
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16089OtherIOWA BOARD OF CERTIFICATION