Provider Demographics
NPI:1548407687
Name:STRUBLE, NICOLE ELISE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELISE
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELISE
Other - Last Name:BLANCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3308 BROADWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6549
Mailing Address - Country:US
Mailing Address - Phone:210-239-2052
Mailing Address - Fax:
Practice Address - Street 1:3308 BROADWAY ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6549
Practice Address - Country:US
Practice Address - Phone:210-239-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX550081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287386101Medicaid
TX287386101Medicaid