Provider Demographics
NPI:1891263836
Name:NICHOLS, CLAIRE THERESE (MA, NCC, LPC-INTERN)
Entity Type:Individual
Prefix:MISS
First Name:CLAIRE
Middle Name:THERESE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA, NCC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 NW STEIDL RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1855
Mailing Address - Country:US
Mailing Address - Phone:541-410-7110
Mailing Address - Fax:
Practice Address - Street 1:1569 SW NANCY WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3234
Practice Address - Country:US
Practice Address - Phone:541-617-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health