Provider Demographics
NPI:1992093660
Name:PARKHOUSE, NICHOLE (PSYD)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PARKHOUSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:PARKHOUSE-WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 S COLUMBIA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5895
Mailing Address - Country:US
Mailing Address - Phone:701-772-1588
Mailing Address - Fax:701-746-6077
Practice Address - Street 1:2100 S COLUMBIA RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5895
Practice Address - Country:US
Practice Address - Phone:701-772-1588
Practice Address - Fax:701-746-6077
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical