Provider Demographics
NPI:1184717282
Name:NICHOLS, ALICE CATHERINE (LICSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CATHERINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:NICHOLS
Other - Last Name:KRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:5723 213TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TER
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2022
Mailing Address - Country:US
Mailing Address - Phone:620-240-0979
Mailing Address - Fax:
Practice Address - Street 1:5723 213TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2022
Practice Address - Country:US
Practice Address - Phone:620-240-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607136751041C0700X
KS1306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200436850BMedicaid
KS207968OtherGREAT WEST HEALTH PARTNER
VA564221OtherVALUE OPTIONS INC
KS069877OtherBLUE CROSS BLUE SHIELD
KS069877Medicare ID - Type Unspecified
VA564221OtherVALUE OPTIONS INC