Provider Demographics
NPI:1285960252
Name:NICHOLSON, MINDY JANE (MS, LCAC, LCMFT)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:JANE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, LCAC, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S SANTA FE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2877
Mailing Address - Country:US
Mailing Address - Phone:785-823-7400
Mailing Address - Fax:785-823-7400
Practice Address - Street 1:134 S SANTA FE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2877
Practice Address - Country:US
Practice Address - Phone:785-823-7400
Practice Address - Fax:785-823-7400
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS854106H00000X
KS403101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200630800AMedicaid