Provider Demographics
NPI:1982753125
Name:NICKLES, MICHELE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:NICKLES
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 GRIFFIN RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4104
Mailing Address - Country:US
Mailing Address - Phone:954-240-3834
Mailing Address - Fax:954-321-3594
Practice Address - Street 1:7450 GRIFFIN RD STE 250
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4104
Practice Address - Country:US
Practice Address - Phone:954-240-3834
Practice Address - Fax:954-321-3594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH5021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health