Provider Demographics
NPI:1710124193
Name:WILLIAMS-MYERS, NICOLE JOSEPHINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JOSEPHINE
Last Name:WILLIAMS-MYERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2831 SAINT ROSE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4841
Mailing Address - Country:US
Mailing Address - Phone:702-589-4822
Mailing Address - Fax:702-589-4823
Practice Address - Street 1:2831 SAINT ROSE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4841
Practice Address - Country:US
Practice Address - Phone:702-589-4822
Practice Address - Fax:702-589-4823
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0572103TC0700X, 103TC2200X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCB227ZOtherMEDICARE PTAN
NVDZ414AOtherMEDICARE GROUP PTAN