| Doctor Name: | JAY NICKEL |
| NPI Number: | 1083863930 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC-S |
| License Number: | |
| Business Practice Address: | 282 Old Kyle Rd Wimberley, TX - 786769701 |
| Business Phone Number: | 5126635941 |
| Business Fax Number: | 5754487404 |
| Mailing Address: | Po Box 2814, WIMBERLEY |
| State: | TX |
| Postal Code: | 786767714 |
| Phone Number: | 5126635941 |
| Fax Number: | 5754487404 |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 05/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |