Provider Demographics
NPI:1700151354
Name:NICHOLSON, ASHLEA MICHELLE (LMAC, LMFT)
Entity type:Individual
Prefix:
First Name:ASHLEA
Middle Name:MICHELLE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LMAC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3822
Mailing Address - Country:US
Mailing Address - Phone:316-285-0015
Mailing Address - Fax:
Practice Address - Street 1:4208 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3822
Practice Address - Country:US
Practice Address - Phone:316-285-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS704101YA0400X
KS2641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)