Provider Demographics
NPI:1205064953
Name:NICHOLAS, PATRICK JAMES
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 VERMONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2921
Mailing Address - Country:US
Mailing Address - Phone:785-764-2121
Mailing Address - Fax:
Practice Address - Street 1:1035 VERMONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2921
Practice Address - Country:US
Practice Address - Phone:785-764-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical