Provider Demographics
NPI:1952651606
Name:NICHOLLS, KATHY ROSALIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ROSALIE
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10094 OAK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5467
Mailing Address - Country:US
Mailing Address - Phone:561-370-4439
Mailing Address - Fax:561-721-6401
Practice Address - Street 1:10094 OAK MEADOW LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-5467
Practice Address - Country:US
Practice Address - Phone:561-370-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8492103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist