Provider Demographics
NPI:1194494682
Name:KLINE, NICOLE (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2810
Mailing Address - Country:US
Mailing Address - Phone:361-244-7295
Mailing Address - Fax:
Practice Address - Street 1:5329 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2810
Practice Address - Country:US
Practice Address - Phone:361-244-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-02-11
Deactivation Date:2021-09-13
Deactivation Code:
Reactivation Date:2022-02-11
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018879101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor