Provider Demographics
NPI:1316616469
Name:ALVA, NICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:ALVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TUXILL SQ
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3915
Mailing Address - Country:US
Mailing Address - Phone:612-229-0970
Mailing Address - Fax:
Practice Address - Street 1:8 TUXILL SQ
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3915
Practice Address - Country:US
Practice Address - Phone:612-229-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist