Provider Demographics
NPI:1598225575
Name:KORDZIK, NIKKALA LEEANN
Entity Type:Individual
Prefix:MS
First Name:NIKKALA
Middle Name:LEEANN
Last Name:KORDZIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 KITTY HAWK RD STE 219
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3829
Mailing Address - Country:US
Mailing Address - Phone:210-566-1280
Mailing Address - Fax:210-579-8533
Practice Address - Street 1:433 KITTY HAWK RD STE 219
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3829
Practice Address - Country:US
Practice Address - Phone:210-566-1280
Practice Address - Fax:210-579-8533
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74795101YP2500X, 101YM0800X
TX13761101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)