Provider Demographics
NPI:1831943109
Name:NICHOLS, MARK L (LMHC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MEADS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1032
Mailing Address - Country:US
Mailing Address - Phone:917-494-7066
Mailing Address - Fax:
Practice Address - Street 1:15 PINE GROVE ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1507
Practice Address - Country:US
Practice Address - Phone:917-494-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health