Provider Demographics
NPI:1396106845
Name:MORITZ, NIKOLE (MS)
Entity type:Individual
Prefix:MS
First Name:NIKOLE
Middle Name:
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:MORITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:3842 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1708
Mailing Address - Country:US
Mailing Address - Phone:260-471-2300
Mailing Address - Fax:
Practice Address - Street 1:3842 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1708
Practice Address - Country:US
Practice Address - Phone:260-471-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor