Provider Demographics
NPI:1710662762
Name:NICKELL, DEVIN NATALIE (LPC-T)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:NATALIE
Last Name:NICKELL
Suffix:
Gender:F
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2632
Mailing Address - Country:US
Mailing Address - Phone:816-616-0107
Mailing Address - Fax:816-616-0107
Practice Address - Street 1:11695 S BLACKBOB RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1058
Practice Address - Country:US
Practice Address - Phone:913-768-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04326-T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional