Elliot Cole Nuckols, MPS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3675 Issued in MN

Practice address

700 Commerce Dr Ste 250
Woodbury, MN 55125-5407

Phone

(270) 268-1835

NPI assigned

Oct 16, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Breanna Nicole Nuckols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1634342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1306509302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E 18TH ST UNIT 615",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554034094",
            "telephone_number": "270-268-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 COMMERCE DR STE 250",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255407",
            "telephone_number": "270-268-1835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUCKOLS",
        "first_name": "ELLIOT",
        "middle_name": "COLE",
        "credential": "MPS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-16",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNA",
            "last_name": "NUCKOLS",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Northstar CFSS
• Novacare Outpatient Rehabilitation East Inc
• Novacare Outpatient Rehabilitation East, Inc.
• Kira Novakofski, MD PHD
• Amy Lynn Novotny
• Nura PLLC
• Lauren Kuhn Nuth, DMD, MSD
• August Nuutinen
• Sarah Nyandoro
• Justin D.W. Nye, D.C.

• Mental Health Counselor in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.