Provider Demographics
NPI:1255136198
Name:NICKLES, TAMESHA D (LPC)
Entity type:Individual
Prefix:
First Name:TAMESHA
Middle Name:D
Last Name:NICKLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2935
Mailing Address - Country:US
Mailing Address - Phone:972-352-3412
Mailing Address - Fax:
Practice Address - Street 1:101 S FANNIN ST STE 113
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3775
Practice Address - Country:US
Practice Address - Phone:972-379-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health