Provider Demographics
NPI:1639532369
Name:NICHOLS, ANTHONY (MA LCPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1810 WOODFIELD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9377
Mailing Address - Country:US
Mailing Address - Phone:217-417-1701
Mailing Address - Fax:
Practice Address - Street 1:1810 WOODFIELD DR STE 201
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9377
Practice Address - Country:US
Practice Address - Phone:217-417-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011713101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional