Provider Demographics
NPI:1801895040
Name:NICOL, LOIS (LCPC)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:NICOL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COVENTRY LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7579
Mailing Address - Country:US
Mailing Address - Phone:815-455-7100
Mailing Address - Fax:815-455-3951
Practice Address - Street 1:500 COVENTRY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7579
Practice Address - Country:US
Practice Address - Phone:815-455-7100
Practice Address - Fax:815-455-3951
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001791101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05619771OtherBCBS