Provider Demographics
NPI:1558785865
Name:BICHLER, NICOLE (MED, NCSP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BICHLER
Suffix:
Gender:F
Credentials:MED, NCSP
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HUZL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCSP
Mailing Address - Street 1:305 MCKINLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1717
Mailing Address - Country:US
Mailing Address - Phone:330-438-2550
Mailing Address - Fax:
Practice Address - Street 1:305 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1717
Practice Address - Country:US
Practice Address - Phone:330-438-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3129687103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool