Provider Demographics
NPI:1578908133
Name:NICHOLS, CANDANCE LEA (LIMHP, LPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:CANDANCE
Middle Name:LEA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LIMHP, LPC, LADC
Other - Prefix:
Other - First Name:CANDI
Other - Middle Name:
Other - Last Name:BOETTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CANDANCE KLEIN
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-4074
Mailing Address - Country:US
Mailing Address - Phone:308-991-3123
Mailing Address - Fax:308-455-6242
Practice Address - Street 1:417 EAST AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2216
Practice Address - Country:US
Practice Address - Phone:308-991-3123
Practice Address - Fax:308-455-6242
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1117101Y00000X
NE982101YA0400X
NE2069101YP2500X
NE4230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1578908133OtherBRIGHT
NE1578908133OtherCIGNA
NE1578908133OtherBLUE CROSS BLUE SHEILD
NE1578908133OtherAETNA
NE1578908133OtherMEDICA