Provider Demographics
NPI:1215994876
Name:NICHOLS, WILLIAM CHARLES (PSYD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3617
Mailing Address - Country:US
Mailing Address - Phone:870-743-6225
Mailing Address - Fax:870-743-6006
Practice Address - Street 1:623 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3617
Practice Address - Country:US
Practice Address - Phone:870-743-6225
Practice Address - Fax:870-743-6006
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00-12P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W126OtherBC BS
AR5C757OtherBC B S GROUP
AR141383019Medicaid
AR148984744Medicaid
AR148984744Medicaid