Connie Sue Nichols, LMHC, IAADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

001526 Issued in IA

Practice address

702 Park Ave
Bettendorf, IA 52722-5684

Phone

(712) 389-0799

NPI assigned

Jun 10, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: connienichols@tdh.allscriptsdirect.net

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.

• All Directions Behavioral Health, Inc.

  • Professional Counselor
  • Winnebago, NE
  • NPI 1528440385
  NPD (past) Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Mental Health

  NPD

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509667200000",
    "number": "1104146380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W 2ND ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511034505",
            "telephone_number": "712-389-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 PARK AVE",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527225684",
            "telephone_number": "712-389-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "CONNIE",
        "middle_name": "SUE",
        "credential": "LMHC, IAADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2017-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "15118",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Roots
• Laura C Newcomb, DPT
• Anh Thu Ngo
• Nicholas Nicchitta, DO
• Amanda Nichols, D.C.
• Laura Nichols, LCSW, BCD
• Zachery Nielsen, LMHC, NCC
• Holly J Nikels, PHD
• Peter J Nordloh, OT
• Kimberly Nicole Norris, AGACNP

• Mental Health Counselor in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2017; 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.