Provider Demographics
NPI:1811399272
Name:ALTAMIRANO, NICOLE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ALTAMIRANO PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:4360 BAKER LN APT B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5527
Mailing Address - Country:US
Mailing Address - Phone:757-671-8208
Mailing Address - Fax:
Practice Address - Street 1:730 S CENTER ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2304
Practice Address - Country:US
Practice Address - Phone:775-671-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NV01467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor