Provider Demographics
NPI:1407571904
Name:NICOLA, MADISON TAYLOR SALSMAN (LMFT, MT-BC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR SALSMAN
Last Name:NICOLA
Suffix:
Gender:F
Credentials:LMFT, MT-BC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:TAYLOR
Other - Last Name:SALSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 CHESTERFIELD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 CHESTERFIELD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4223
Practice Address - Country:US
Practice Address - Phone:147-698-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13585225A00000X
CA150703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist