Active NPI
Mindy Jane Nicholson, MS, LCAC, LCMFT
- Marriage & Family Therapist
- Salina, KS
National Provider Identifier
1285960252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 854
- Practice address
- 134 S Santa Fe Ave
Suite 130
Salina, KS 67401-2877 - Phone
- (785) 823-7400
- Fax
- (785) 823-7400
- NPI assigned
- Oct 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 854 | KS | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 403 | KS |
Addresses
Primary practice location
134 S Santa Fe Ave
Suite 130
Salina, KS 67401-2877
Mailing address
134 S Santa Fe Ave
Suite 130
Salina, KS 67401-2877
Phone (785) 823-7400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200630800A | Medicaid | KS |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 854 | KS | MD | Marriage & Family Therapist |
| 403 | KS | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sandstone Bridge Center, LLC | Addiction (Substance Use Disorder) | Past | Accepting new patients |
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.
-
- Marriage & Family Therapist
- Salina, KS
- NPI 1982901724
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468281600000",
"number": "1285960252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 S SANTA FE AVE",
"address_2": "SUITE 130",
"city": "SALINA",
"state": "KS",
"postal_code": "674012877",
"telephone_number": "785-823-7400",
"fax_number": "785-823-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 S SANTA FE AVE",
"address_2": "SUITE 130",
"city": "SALINA",
"state": "KS",
"postal_code": "674012877",
"telephone_number": "785-823-7400",
"fax_number": "785-823-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "MINDY",
"middle_name": "JANE",
"credential": "MS, LCAC, LCMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-27",
"last_updated": "2016-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "KS",
"license": "854",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KS",
"license": "403",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200630800A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salina, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.