Provider Demographics
NPI:1659926491
Name:NEAL, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NEAL
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 1:17317 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ESPARTO
Mailing Address - State:CA
Mailing Address - Zip Code:95627-2137
Mailing Address - Country:US
Mailing Address - Phone:530-787-4110
Mailing Address - Fax:
Practice Address - Street 1:425 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1609
Practice Address - Country:US
Practice Address - Phone:707-416-6469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health