Provider Demographics
NPI:1487281150
Name:LOZANO, NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ASU STATION #10907
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76909-0907
Mailing Address - Country:US
Mailing Address - Phone:325-486-6116
Mailing Address - Fax:
Practice Address - Street 1:8001 S 15TH ST STE C
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9617
Practice Address - Country:US
Practice Address - Phone:402-483-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty