Provider Demographics
NPI:1659816684
Name:MCNICHOLS, BRANDON J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:MCNICHOLS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR STE 109
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3916
Mailing Address - Country:US
Mailing Address - Phone:808-554-2867
Mailing Address - Fax:808-824-3345
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 109
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3916
Practice Address - Country:US
Practice Address - Phone:808-554-2867
Practice Address - Fax:808-824-3345
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical