Provider Demographics
NPI:1568115566
Name:MALECEK, NICOLE LEE (MPS LPCC LADC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MALECEK
Suffix:
Gender:F
Credentials:MPS LPCC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERSITY AVE W STE 500
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3828
Mailing Address - Country:US
Mailing Address - Phone:651-242-5540
Mailing Address - Fax:651-209-6341
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 500
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3828
Practice Address - Country:US
Practice Address - Phone:651-242-5540
Practice Address - Fax:651-209-6341
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3071OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR