Provider Demographics
NPI:1336184985
Name:NICHOLS, DEBORAH ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:509 MDG
Mailing Address - Street 2:331 SIJAN AVENUE
Mailing Address - City:WHITEMAN AFB
Mailing Address - State:MO
Mailing Address - Zip Code:65305
Mailing Address - Country:US
Mailing Address - Phone:660-687-4412
Mailing Address - Fax:
Practice Address - Street 1:509 MDG
Practice Address - Street 2:331 SIJAN AVENUE
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305
Practice Address - Country:US
Practice Address - Phone:660-687-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0046721041C0700X
MOSW0046721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497884338Medicaid
MO23810OtherBCBS
MO23810OtherBCBS