Basic Information
| Provider Information | |||||||||
| NPI: | 1972729721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICKELL | ||||||||
| FirstName: | EUGENIE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9046 POST OAK LN | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381254400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017569916 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 427 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381262023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015770200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1946 | TN | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 1073 | AL | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.