Provider Demographics
NPI:1336884519
Name:NICHOLSON, ALTHEIN L (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALTHEIN
Middle Name:L
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N BULLARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2711
Mailing Address - Country:US
Mailing Address - Phone:623-282-4586
Mailing Address - Fax:623-263-2917
Practice Address - Street 1:1360 N BULLARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2711
Practice Address - Country:US
Practice Address - Phone:623-282-4586
Practice Address - Fax:623-263-2917
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty