Provider Demographics
NPI:1063571941
Name:NICHOLS, STEVEN LEROY (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEROY
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 W ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4307
Mailing Address - Country:US
Mailing Address - Phone:559-203-6692
Mailing Address - Fax:
Practice Address - Street 1:4711 W ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4307
Practice Address - Country:US
Practice Address - Phone:559-203-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical