Provider Demographics
NPI:1851798979
Name:NICHOLS, ANTHONY TODD (PHD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TODD
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1918
Mailing Address - Country:US
Mailing Address - Phone:952-475-2818
Mailing Address - Fax:952-475-3356
Practice Address - Street 1:102 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1918
Practice Address - Country:US
Practice Address - Phone:952-475-2818
Practice Address - Fax:952-475-3356
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5852103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent