Provider Demographics
NPI:1356223176
Name:NICHOLS, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18717 PRAIRIE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6699
Mailing Address - Country:US
Mailing Address - Phone:951-760-0201
Mailing Address - Fax:951-760-0201
Practice Address - Street 1:1187 LAKEWOOD FARMINGDALE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8689
Practice Address - Country:US
Practice Address - Phone:844-525-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24393144106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician