Provider Demographics
NPI:1821667221
Name:NOVAK, NICOLETTE MARIE (TLMHC)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:MARIE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OFFICE PARK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2509
Mailing Address - Country:US
Mailing Address - Phone:515-471-2357
Mailing Address - Fax:
Practice Address - Street 1:1001 OFFICE PARK RD STE 205
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2509
Practice Address - Country:US
Practice Address - Phone:515-471-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional