Active NPI
Alyssa Nichols, EDS
- School Psychologist
- Goshen, IN
National Provider Identifier
1255152690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1599980
- Practice address
- 215 Dewey Ave
Goshen, IN 46526-2119 - Phone
- (574) 533-3151
- NPI assigned
- Oct 18, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1599980 | IN | Primary |
Addresses
Primary practice location
215 Dewey Ave
Goshen, IN 46526-2119
Mailing address
215 Dewey Ave
Goshen, IN 46526-2119
Phone (574) 533-3151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1599980 | IN | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729209600000",
"number": "1255152690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 DEWEY AVE",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465262119",
"telephone_number": "574-533-3151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 DEWEY AVE",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465262119",
"telephone_number": "574-533-3151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "ALYSSA",
"credential": "EDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-18",
"last_updated": "2024-10-18",
"certification_date": "2024-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IN",
"license": "1599980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.