Provider Demographics
NPI:1427341825
Name:BEREOLOS, NICOLE MARGARET (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARGARET
Last Name:BEREOLOS
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 COYOTE RUN
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8805
Mailing Address - Country:US
Mailing Address - Phone:972-768-7994
Mailing Address - Fax:972-692-0976
Practice Address - Street 1:5900 S LAKE FOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2238
Practice Address - Country:US
Practice Address - Phone:972-768-7994
Practice Address - Fax:972-692-0976
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01228103TC0700X
TX36061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical