Provider Demographics
NPI:1588214548
Name:NIKOLS, JANESSA (LCP)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:NIKOLS
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 N NORTHWEST HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1363
Mailing Address - Country:US
Mailing Address - Phone:312-488-9567
Mailing Address - Fax:
Practice Address - Street 1:6650 N NORTHWEST HWY STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1363
Practice Address - Country:US
Practice Address - Phone:312-488-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013877101YP2500X
IL178015127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional