Provider Demographics
NPI:1922989821
Name:NICHOLS, JILL MICHELLE (LMFT, MA, BS)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MICHELLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMFT, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 CYPRESS POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-3503
Mailing Address - Country:US
Mailing Address - Phone:402-227-5095
Mailing Address - Fax:
Practice Address - Street 1:1536 SUNRISE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6204
Practice Address - Country:US
Practice Address - Phone:407-488-4892
Practice Address - Fax:863-582-9993
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist