Provider Demographics
NPI:1285401109
Name:COREY, NICOLE L (LPC-A, MA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:COREY
Suffix:
Gender:F
Credentials:LPC-A, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 E GRAND AVE APT 2106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4164
Mailing Address - Country:US
Mailing Address - Phone:406-493-7655
Mailing Address - Fax:
Practice Address - Street 1:7510 E GRAND AVE APT 2106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4164
Practice Address - Country:US
Practice Address - Phone:406-493-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional