Provider Demographics
NPI:1588227284
Name:NICHOLS, JOLENE (LCAC)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17182 S KILLCREEK RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-7848
Mailing Address - Country:US
Mailing Address - Phone:785-202-0140
Mailing Address - Fax:
Practice Address - Street 1:11511 W 83RD TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1532
Practice Address - Country:US
Practice Address - Phone:844-202-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty