Provider Demographics
NPI:1609548585
Name:NICOLAS, YARLIE RUTH (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:YARLIE
Middle Name:RUTH
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7957 N UNIVERSITY DR # 1037
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2601
Mailing Address - Country:US
Mailing Address - Phone:954-709-0916
Mailing Address - Fax:
Practice Address - Street 1:6413 NW 72ND AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5518
Practice Address - Country:US
Practice Address - Phone:954-709-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist