Provider Demographics
NPI:1194998179
Name:NICOLET, RONALD G (MA, LMHC, LCAC, NCC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:G
Last Name:NICOLET
Suffix:
Gender:M
Credentials:MA, LMHC, LCAC, NCC
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 5235
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-5235
Mailing Address - Country:US
Mailing Address - Phone:260-918-6323
Mailing Address - Fax:260-242-5338
Practice Address - Street 1:1910 SAINT JOE CENTER RD
Practice Address - Street 2:SUITE 13
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-918-6323
Practice Address - Fax:260-755-5867
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001898A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100190820Medicaid
IN201029880Medicaid