Provider Demographics
NPI:1578299905
Name:NATASHA NICHOLS LLC
Entity Type:Organization
Organization Name:NATASHA NICHOLS LLC
Other - Org Name:NEW WATERS WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:440-732-3989
Mailing Address - Street 1:34194 AURORA RD # 184
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3801
Mailing Address - Country:US
Mailing Address - Phone:440-732-3989
Mailing Address - Fax:
Practice Address - Street 1:32886 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2264
Practice Address - Country:US
Practice Address - Phone:440-732-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284889Medicaid