Individual provider Active NPI

Jennifer Nichols, MA, LPC-S

  • Mental Health Counselor
  • Cypress, TX
National Provider Identifier
1073927620
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
19042 Issued in TX
Practice address
17510 Huffmeister Rd
Suite 103
Cypress, TX 77429-6785
Phone
(832) 457-3153
NPI assigned
Jun 11, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 19042 TX
Mental Health Counselor 101YM0800X 19042 TX Primary
Professional Counselor 101YP2500X 19042 TX

Addresses

Primary practice location

17510 Huffmeister Rd
Suite 103
Cypress, TX 77429-6785

Mailing address

12614 Manorwood LN
Cypress, TX 77429-3631
Phone (832) 457-3153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260506001592 TX Practitioner - Mental Health Counselor 2769950955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2002
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Riverview Blvd
Methuen, MA 01844-6026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
19042TXMDMental Health Counselor

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1073927620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12614 MANORWOOD LN",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774293631",
            "telephone_number": "832-457-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17510 HUFFMEISTER RD",
            "address_2": "SUITE 103",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774296785",
            "telephone_number": "832-457-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "19042",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "19042",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "19042",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cypress, TX

Sources for this page

Verify at the official NPI Registry.