Provider Demographics
NPI:1912089632
Name:NICHOLS, KAREN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:D
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 130TH AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1752
Mailing Address - Country:US
Mailing Address - Phone:425-889-1240
Mailing Address - Fax:425-889-1249
Practice Address - Street 1:2320 130TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1752
Practice Address - Country:US
Practice Address - Phone:425-889-1240
Practice Address - Fax:425-889-1249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8877390OtherPTAN
WA8854947Medicare ID - Type UnspecifiedGROUP ID
WAG8877390OtherPTAN
WAG8877390Medicare PIN
WA8854948Medicare ID - Type UnspecifiedINDIVIDUAL ID