Provider Demographics
NPI:1265242770
Name:NICKEL, JOEL (MS)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:NICKEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14209 84TH TER
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2826
Mailing Address - Country:US
Mailing Address - Phone:727-804-9538
Mailing Address - Fax:
Practice Address - Street 1:1501 S PINELLAS AVE STE QANDH
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-547-3692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health