Provider Demographics
NPI:1699937573
Name:NICHOLS, BRENDA KAY (RADT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:320 W OAK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4929
Mailing Address - Country:US
Mailing Address - Phone:559-625-3420
Mailing Address - Fax:
Practice Address - Street 1:320 W OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4929
Practice Address - Country:US
Practice Address - Phone:559-625-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1720-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)