Provider Demographics
NPI:1154339844
Name:NICOL, LAURIE LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LYNN
Last Name:NICOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3353
Mailing Address - Country:US
Mailing Address - Phone:307-217-0377
Mailing Address - Fax:
Practice Address - Street 1:902 N 8TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2332
Practice Address - Country:US
Practice Address - Phone:307-857-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-5641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical