| Doctor Name: | ROXANNE L NICHOLS |
| NPI Number: | 1003101189 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LCPC |
| License Number: | LCPC4245 |
| Business Practice Address: | Boise State University 1910 University Drive Boise, ID - 837251351 |
| Business Phone Number: | 2084262869 |
| Business Fax Number: | 2084263005 |
| Mailing Address: | Boise State University, 1910 University Drive BOISE |
| State: | ID |
| Postal Code: | 837251351 |
| Phone Number: | 2084262869 |
| Fax Number: | 2084263005 |
| NPI Enumeration Date: | 06/16/2011 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LCPC4245 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |