Provider Demographics
NPI:1598571358
Name:NICHOLSON, IAN (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2232
Mailing Address - Country:US
Mailing Address - Phone:805-563-2515
Mailing Address - Fax:
Practice Address - Street 1:720 SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2232
Practice Address - Country:US
Practice Address - Phone:805-563-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program