Nichols, Kenneth R
Nichols, Kenneth R is an individual health care provider with primary practice located at 1001 W Broadway Ste D , Farmington NM 87401-5638. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Nichols, Kenneth R can be contacted via phone (505) 325-0238.Contact Information
Primary practice address
1001 W Broadway Ste D
Farmington NM 87401-5638
Phone: (505) 325-0238
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C-11080 | New Mexico |
Profile Details
| NPI number | 1548707649 |
|---|---|
| LBN Legal business name | Nichols, Kenneth R |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2017 |
| Last updated | Aug 31st, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548707649 | NPPES |
| New Mexico | MEDICAID | 1649724055 | |
| New Mexico | MEDICAID | 1619475944 |
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