Provider Demographics
NPI:1073359816
Name:BEHRENS, NICOLE MARIE (MS,LPCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:MS,LPCC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:BOESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3619
Mailing Address - Country:US
Mailing Address - Phone:507-432-1600
Mailing Address - Fax:
Practice Address - Street 1:1420 N STATE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3619
Practice Address - Country:US
Practice Address - Phone:507-235-6070
Practice Address - Fax:855-847-9876
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health