Provider Demographics
NPI:1912305954
Name:ANDERSON, NICOLE NICHELLE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:NICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:NICHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3820 KENZIE CT
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-5011
Mailing Address - Country:US
Mailing Address - Phone:214-673-3114
Mailing Address - Fax:
Practice Address - Street 1:3820 KENZIE CT
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-5011
Practice Address - Country:US
Practice Address - Phone:214-673-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health