Provider Demographics
NPI:1184717282
Name:NICHOLS, ALICE CATHERINE (LSCSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CATHERINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:NICHOLS
Other - Last Name:KRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:911 E CENTENNIAL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-231-5130
Mailing Address - Fax:620-235-7101
Practice Address - Street 1:3101 N MICHIGAN
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-231-5130
Practice Address - Fax:620-235-7101
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069877OtherBLUE CROSS BLUE SHIELD
KS207968OtherGREAT WEST HEALTH PARTNER
KS200436850BMedicaid
VA564221OtherVALUE OPTIONS INC
KS069877Medicare ID - Type Unspecified
VA564221OtherVALUE OPTIONS INC