Provider Demographics
NPI:1194495804
Name:NICHOLLS, KRISTINA KAY (LCPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KAY
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-435-8481
Mailing Address - Fax:406-657-3735
Practice Address - Street 1:1020 N 27TH ST STE 310
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0752
Practice Address - Country:US
Practice Address - Phone:406-435-8481
Practice Address - Fax:406-657-3735
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1385101YM0800X
MT43605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health