Mario George Nicolas, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

37499 Issued in TX

Practice address

1100 Wilford Hall Loop, BLDG 4554
Attn: 59 MDW/SGHC
Jbsa Lackland, TX 78236

Phone

(210) 292-6225

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Uhs BH Telepsych FL, PLLC

  • Psychiatry Physician
  • Ponte Vedra Beach, FL
  • NPI 1790453033

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1043380116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP, BLDG 4554",
            "address_2": "ATTN: 59 MDW/SGHC",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "78236",
            "telephone_number": "210-292-6225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Wilford Hall Loop, BLDG 4554",
            "address_2": "ATTN: 59 MDW/SGHC",
            "address_purpose": "LOCATION",
            "city": "JBSA Lackland",
            "state": "TX",
            "postal_code": "78236",
            "country_code": "US",
            "telephone_number": "210-292-6225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOLAS",
        "first_name": "MARIO",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "37499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Nicole Nephew
• CHI Lan Nguyen-Johnson, PHARMD
• An Nguyen, PHARMD
• Kristen Benae Nichols, D.D.S.
• Summer Nicholson
• Giovanda D Norman, PHD
• Gianni North
• Sean O'Brien, MD
• Martin R Oberg, MD
• Jarrod Paul Odom, MD

• Psychologist in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.