Provider Demographics
NPI:1023210291
Name:AMERIUS SARGEANT, NICKIE LYNDANNE (MFT)
Entity type:Individual
Prefix:MS
First Name:NICKIE
Middle Name:LYNDANNE
Last Name:AMERIUS SARGEANT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:ANN
Other - Last Name:SARGEANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:TRES PINOS
Mailing Address - State:CA
Mailing Address - Zip Code:95075
Mailing Address - Country:US
Mailing Address - Phone:831-628-3336
Mailing Address - Fax:
Practice Address - Street 1:920 SUNNYSLOPE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023
Practice Address - Country:US
Practice Address - Phone:831-636-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT19742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist