Provider Demographics
NPI:1932399524
Name:NICHOLAS, DONALD RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:NICHOLAS
Suffix:
Gender:M
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:BALL STATE UNIV
Mailing Address - Street 2:DEPARTMENT OF COUNSELING PSYCHOLOGY, TC622
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-1099
Mailing Address - Country:US
Mailing Address - Phone:765-285-8058
Mailing Address - Fax:765-285-2067
Practice Address - Street 1:BALL STATE UNIV
Practice Address - Street 2:DEPARTMENT OF COUNSELING PSYCHOLOGY, TC622
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-1099
Practice Address - Country:US
Practice Address - Phone:765-285-8058
Practice Address - Fax:765-285-2067
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040120A103TC1900X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth