Provider Demographics
NPI:1265949614
Name:NICHOLSON, BRENDA D (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:NICHOLSON
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 1:1229 E PLEASANT RUN RD STE 309
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4209
Mailing Address - Country:US
Mailing Address - Phone:972-228-5655
Mailing Address - Fax:
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 309
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4209
Practice Address - Country:US
Practice Address - Phone:972-228-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health