Bornell Nicholson, PHD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LF61468637 Issued in WA

Practice address

5901 N Lidgerwood St Ste 223
Spokane, WA 99208-1122

Phone

(509) 444-8200

Fax

(509) 434-0392

NPI assigned

Jun 30, 2016

Sex

Male

Sole proprietor

No

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

Enrolled in WA

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

Specialty

Marriage and Family Therapist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Association of SpokaneGroup PAC ID 9638063217, 222 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1326005851
  Medicare reassignment Care Compare group NPD
• Fireside Psychotherapy, PLLC

  • Marriage & Family Therapist
  • Spokane, WA
  • NPI 1659141786
  NPD Authorized official
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane Valley, WA
  • NPI 1437526456
  NPD
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1679363592
  NPD
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1295946101
  NPD (past)
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1528279437
  NPD (past)
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1598976409
  NPD (past)
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1770972754
  NPD (past)
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Deer Park, WA
  • NPI 1912085135
  NPD (past)
• Springtree Counseling, P.C.

  • Mental Health Counselor
  • Evanston, IL
  • NPI 1902911860
  NPD (past)

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752883200000",
    "number": "1295186294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N LIDGERWOOD ST STE 223",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081122",
            "telephone_number": "509-444-8200",
            "fax_number": "509-434-0392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "70 S River St",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605065185",
            "country_code": "US",
            "telephone_number": "630-844-2662",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1007 Church St Ste 302",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602015912",
            "country_code": "US",
            "telephone_number": "630-450-0625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "BORNELL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-30",
        "last_updated": "2025-07-19",
        "certification_date": "2025-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF61468637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joni C Nichols, M.D.
• Kelly Nichols
• Kyle Gerald Boyd Nichols, BA
• Nancy Lynn Nichols, M.D.
• Sidney Lynn Nichols
• Dustin R Nicholson
• Kelly Nicholson
• Samual Allen Nicholson, CRNA
• Skylar Marie Nicholson
• Catherine Ann Nickens, LMHC

• Marriage & Family Therapist in Spokane, WA
• Providers in Spokane, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.