Provider Demographics
NPI:1790141422
Name:LAWSON, NICOLE (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LAWSON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5113
Mailing Address - Country:US
Mailing Address - Phone:888-374-5066
Mailing Address - Fax:
Practice Address - Street 1:9000 W THUNDERBIRD RD STE 115
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4451
Practice Address - Country:US
Practice Address - Phone:888-374-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1300106H00000X
AZ16003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist