Provider Demographics
NPI:1962435784
Name:NICHOLS ANDERSON, CINDY NICHOLS (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:NICHOLS
Last Name:NICHOLS ANDERSON
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 5TH ST.
Mailing Address - Street 2:STE 202
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2939
Mailing Address - Country:US
Mailing Address - Phone:319-358-6520
Mailing Address - Fax:319-538-0093
Practice Address - Street 1:1303 5TH ST.
Practice Address - Street 2:STE 202
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2939
Practice Address - Country:US
Practice Address - Phone:319-358-6520
Practice Address - Fax:319-538-0093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00991103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical