Provider Demographics
NPI:1578814307
Name:MONTOUR, NICHOLSON (CLINICIAN)
Entity Type:Individual
Prefix:
First Name:NICHOLSON
Middle Name:
Last Name:MONTOUR
Suffix:
Gender:M
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3528
Mailing Address - Country:US
Mailing Address - Phone:402-475-8717
Mailing Address - Fax:402-475-8721
Practice Address - Street 1:2202 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3559
Practice Address - Country:US
Practice Address - Phone:402-475-5161
Practice Address - Fax:402-475-8721
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health