1821161787 NPI number — MR. ANDREW NICHOLS C NICHOLS MSW, LCSW

Table of content: MR. ANDREW NICHOLS C NICHOLS MSW, LCSW (NPI 1821161787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821161787 NPI number — MR. ANDREW NICHOLS C NICHOLS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
ANDREW NICHOLS
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821161787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1761 S NAPERVILLE RD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60189-5846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-260-0606
Provider Business Mailing Address Fax Number:
630-260-1049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1761 S NAPERVILLE RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60189-5846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-260-0606
Provider Business Practice Location Address Fax Number:
630-260-1049
Provider Enumeration Date:
11/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149006444 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)