Provider Demographics
NPI:1952894388
Name:TAGERT, NICOLLE MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:MARIE
Last Name:TAGERT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1720
Mailing Address - Country:US
Mailing Address - Phone:610-506-7838
Mailing Address - Fax:
Practice Address - Street 1:593 BETHLEHEM PIKE STE 5
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9709
Practice Address - Country:US
Practice Address - Phone:610-257-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health