| Doctor Name: | MR. JASEN RALPH NICHOLS |
| NPI Number: | 1528332921 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | 1011 |
| Business Practice Address: | 216 W North St Harrisville, WV - 263621047 |
| Business Phone Number: | 3046435399 |
| Business Fax Number: | 3046435398 |
| Mailing Address: | 216 W. North St., C/o Spaulding Psychological Services, Pllc HARRISVILLE |
| State: | WV |
| Postal Code: | 263621047 |
| Phone Number: | 3046435399 |
| Fax Number: | 3046435398 |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 03/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |