Provider Demographics
NPI:1154869428
Name:NEXUS ONLINE COUNSELING PLLC
Entity type:Organization
Organization Name:NEXUS ONLINE COUNSELING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:509-863-2601
Mailing Address - Street 1:2600 E SELTICE WAY # 113
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7991
Mailing Address - Country:US
Mailing Address - Phone:509-863-2601
Mailing Address - Fax:
Practice Address - Street 1:2600 E SELTICE WAY # 113
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7991
Practice Address - Country:US
Practice Address - Phone:509-863-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-358511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty