Basic Information
| Provider Information | |||||||||
| NPI: | 1548845225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOBLER | ||||||||
| FirstName: | NICHOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 AMERICAN BLVD E STE 8 | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127677222 | ||||||||
| FaxNumber: | 6127285301 | ||||||||
| Practice Location | |||||||||
| Address1: | 17034 KETTLE LN APT 313 | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346380063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307262402 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2021 | ||||||||
| LastUpdateDate: | 04/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MT4051 | FL | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 4032 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.