Provider Demographics
NPI:1275013807
Name:BASCOU, NICHOLETT ALEXANDRIA (LPCC 13440)
Entity type:Individual
Prefix:MRS
First Name:NICHOLETT
Middle Name:ALEXANDRIA
Last Name:BASCOU
Suffix:
Gender:F
Credentials:LPCC 13440
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 SAN ANTONIO CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7209
Mailing Address - Country:US
Mailing Address - Phone:209-598-5783
Mailing Address - Fax:
Practice Address - Street 1:2050 PEABODY RD STE 300
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6695
Practice Address - Country:US
Practice Address - Phone:707-727-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC13440101YM0800X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health