Provider Demographics
NPI:1992196653
Name:TIEKEN, NICHOLAS LEROY (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEROY
Last Name:TIEKEN
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:TIEKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:580 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4407
Mailing Address - Country:US
Mailing Address - Phone:775-786-4673
Mailing Address - Fax:
Practice Address - Street 1:580 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4407
Practice Address - Country:US
Practice Address - Phone:775-786-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9739-C1041C0700X, 1041C0700X
NV07010-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty