Provider Demographics
NPI:1063896553
Name:MCNICHOLS, STEPHANIE JEAN (MA, PLMHP, PLDAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:MCNICHOLS
Suffix:
Gender:F
Credentials:MA, PLMHP, PLDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 WOODSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5044
Mailing Address - Country:US
Mailing Address - Phone:402-440-6496
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2344
Practice Address - Country:US
Practice Address - Phone:402-236-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1318101YA0400X
NE1345101YA0400X
NE10548101YM0800X
NE2368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)