Provider Demographics
NPI:1154337533
Name:JECKELL, NICOLE (MA, LPC, NCC)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:JECKELL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:7280 NW 87TH TERRACE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3706
Mailing Address - Country:US
Mailing Address - Phone:816-841-7735
Mailing Address - Fax:816-817-0712
Practice Address - Street 1:7280 NW 87TH TERRACE
Practice Address - Street 2:SUITE 210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3706
Practice Address - Country:US
Practice Address - Phone:816-841-7735
Practice Address - Fax:816-817-0712
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496006800Medicaid