Provider Demographics
NPI:1780862649
Name:KAREN D. NICHOLS, PH.D., P.S.
Entity Type:Organization
Organization Name:KAREN D. NICHOLS, PH.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-889-1240
Mailing Address - Street 1:11808 NORTHUP WAY
Mailing Address - Street 2:W 150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1936
Mailing Address - Country:US
Mailing Address - Phone:425-889-1240
Mailing Address - Fax:425-889-1249
Practice Address - Street 1:11808 NORTHUP WAY
Practice Address - Street 2:W 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1936
Practice Address - Country:US
Practice Address - Phone:425-889-1240
Practice Address - Fax:425-889-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8854947Medicare PIN
WAQ50046Medicare UPIN
WA8854948Medicare PIN