| Doctor Name: | JOHN W NICKISSON |
| NPI Number: | 1184751521 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW, CAADC |
| License Number: | 2-00774 |
| Business Practice Address: | 18554 Northland Dr Big Rapids, MI - 493078788 |
| Business Phone Number: | 2313496111 |
| Business Fax Number: | 2317966280 |
| Mailing Address: | 18554 Northland Dr, BIG RAPIDS |
| State: | MI |
| Postal Code: | 493078788 |
| Phone Number: | 2313496111 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 11/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2-00774 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |