| Doctor Name: | DAVID L NICHOLS |
| NPI Number: | 1063409852 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 943-057 |
| Business Practice Address: | 1244 Wisconsin Ave Suite 303 Racine, WI - 534031987 |
| Business Phone Number: | 2626355520 |
| Business Fax Number: | 2626355530 |
| Mailing Address: | 1244 Wisconsin Ave, Suite 303 RACINE |
| State: | WI |
| Postal Code: | 534031987 |
| Phone Number: | 2626355520 |
| Fax Number: | 2626355530 |
| NPI Enumeration Date: | 10/05/2005 |
| NPI Last Update Date: | 02/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 943-057 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |