Provider Demographics
NPI:1821725904
Name:SCHLANGER, NICKELLA
Entity Type:Individual
Prefix:
First Name:NICKELLA
Middle Name:
Last Name:SCHLANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E COLORADO BLVD STE 2082
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1986
Mailing Address - Country:US
Mailing Address - Phone:844-669-7827
Mailing Address - Fax:
Practice Address - Street 1:177 E COLORADO BLVD STE 2082
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1986
Practice Address - Country:US
Practice Address - Phone:844-669-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health