Provider Demographics
NPI:1609883040
Name:NICHOLS, GEORGE T (PHD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:T
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 VAQUERO RD
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-2734
Mailing Address - Country:US
Mailing Address - Phone:831-642-9613
Mailing Address - Fax:
Practice Address - Street 1:1014 VAQUERO RD
Practice Address - Street 2:
Practice Address - City:PEBBLE BEACH
Practice Address - State:CA
Practice Address - Zip Code:93953-2734
Practice Address - Country:US
Practice Address - Phone:831-642-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical