Provider Demographics
NPI:1528134186
Name:NICHOLS, JOY G (PHD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:G
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:PO BOX 33932
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-675-4783
Mailing Address - Fax:318-675-6382
Practice Address - Street 1:2195 CLUB CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4162
Practice Address - Country:US
Practice Address - Phone:909-651-1899
Practice Address - Fax:909-558-3809
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY20567103G00000X
LA1062103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist