Provider Demographics
NPI:1467995571
Name:BOOK, NICOLE M (MS, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BOOK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PREMIER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2943
Mailing Address - Country:US
Mailing Address - Phone:314-544-3800
Mailing Address - Fax:314-843-0552
Practice Address - Street 1:5 PREMIER DR STE 200
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2943
Practice Address - Country:US
Practice Address - Phone:314-544-3800
Practice Address - Fax:314-843-0552
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional