Provider Demographics
NPI:1710126214
Name:NICHOLS, BARBARA K (MA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 UNION AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3162
Mailing Address - Country:US
Mailing Address - Phone:408-550-3315
Mailing Address - Fax:408-879-0915
Practice Address - Street 1:30 UNION AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3162
Practice Address - Country:US
Practice Address - Phone:408-550-3315
Practice Address - Fax:408-879-0915
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist