Provider Demographics
NPI:1063557296
Name:NICHOLS, PATRICIA A (LCPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 24TH ST W
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2677
Mailing Address - Country:US
Mailing Address - Phone:406-670-3956
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1643 24TH ST W
Practice Address - Street 2:SUITE 108
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2677
Practice Address - Country:US
Practice Address - Phone:406-670-3956
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1178 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256751Medicaid
MT000742280OtherBCBS