Provider Demographics
NPI:1710512975
Name:NICHOLS, ALEX ANNE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-0343
Mailing Address - Country:US
Mailing Address - Phone:325-660-4429
Mailing Address - Fax:
Practice Address - Street 1:1401 SANDIA PLZ
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4356
Practice Address - Country:US
Practice Address - Phone:325-660-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional