Provider Demographics
NPI:1750870853
Name:NICHOLS, NATASHA M (LPCC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34194 AURORA RD # 184
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3801
Mailing Address - Country:US
Mailing Address - Phone:216-235-7909
Mailing Address - Fax:
Practice Address - Street 1:32886 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2264
Practice Address - Country:US
Practice Address - Phone:440-732-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700438101YP2500X
OHE.2102078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284889Medicaid