Provider Demographics
NPI:1598042467
Name:PERALTA AZOR, NICHOLE (LIMHP, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PERALTA AZOR
Suffix:
Gender:F
Credentials:LIMHP, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BEAVER CREEK ESTATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694
Mailing Address - Country:US
Mailing Address - Phone:308-249-7853
Mailing Address - Fax:308-365-5122
Practice Address - Street 1:731 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1747
Practice Address - Country:US
Practice Address - Phone:308-249-7853
Practice Address - Fax:308-365-5122
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2125101YP2500X
NE1240101YM0800X
NE1256101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026729100Medicaid