Provider Demographics
NPI:1992141196
Name:NICHOLAS, LARRY D (MA LMHC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:D
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LMHCA
Mailing Address - Street 1:753A HARVARD AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4625
Mailing Address - Country:US
Mailing Address - Phone:206-499-5669
Mailing Address - Fax:
Practice Address - Street 1:753A HARVARD AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4625
Practice Address - Country:US
Practice Address - Phone:206-499-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60165460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist