Organization Name: | JULIA M NICKLE LMHC, INC |
NPI Number: | 1104196369 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JULIA M NICKLE (OWNER) |
Mailing Address: | 3997 Commons Dr W Ste C Destin |
State: | FL US |
Postal Code: | 325418443 |
Phone Number: | 8503765107 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2012 |
NPI Last Update Date: | 02/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH8238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |