Provider Demographics
NPI:1457690174
Name:NICHOLSON, CALLY ELIZABETH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CALLY
Middle Name:ELIZABETH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:CALLY
Other - Middle Name:ELIZABETH
Other - Last Name:AGNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4130
Practice Address - Street 1:2101 W LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2506
Practice Address - Country:US
Practice Address - Phone:903-315-2620
Practice Address - Fax:903-315-3513
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional