1578908133 NPI number — MRS. CANDANCE LEA NICHOLS LIMHP, LPC, LADC

Table of content: (NPI 1821870817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578908133 NPI number — MRS. CANDANCE LEA NICHOLS LIMHP, LPC, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
CANDANCE
Provider Middle Name:
LEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LIMHP, LPC, LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOETTCHER
Provider Other First Name:
CANDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CANDANCE KLEIN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578908133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDREGE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68949-4074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-991-3123
Provider Business Mailing Address Fax Number:
308-455-6242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLDREGE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68949-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-991-3123
Provider Business Practice Location Address Fax Number:
308-455-6242
Provider Enumeration Date:
05/08/2013

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: 101Y00000X , with the licence number:  1117 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 982 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2069 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4230 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578908133 . This is a "BRIGHT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1578908133 . This is a "CIGNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1578908133 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1578908133 . This is a "AETNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1578908133 . This is a "MEDICA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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