Provider Demographics
NPI:1912056854
Name:NICKELL, LENECIA DEON (MA)
Entity Type:Individual
Prefix:MRS
First Name:LENECIA
Middle Name:DEON
Last Name:NICKELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LENECIA
Other - Middle Name:DEON
Other - Last Name:BOWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY E STE 150-265
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1529
Mailing Address - Country:US
Mailing Address - Phone:281-900-7573
Mailing Address - Fax:
Practice Address - Street 1:9659 N SAM HOUSTON PKWY E STE 150-265
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1529
Practice Address - Country:US
Practice Address - Phone:281-900-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50490101YM0800X
TX66310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health