Active NPI
Nichole A Williams, LMHC
- Mental Health Counselor
- Bloomington, IN
National Provider Identifier
1407585367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39003462A
- Practice address
- 3671 N Lauren LN
Bloomington, IN 47404-9206 - Phone
- (317) 508-7823
- NPI assigned
- Jun 7, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39003462A | IN | Primary |
Addresses
Primary practice location
3671 N Lauren LN
Bloomington, IN 47404-9206
Mailing address
PO Box 62
Ellettsville, IN 47429-0062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39003462A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732665600000",
"number": "1407585367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 62",
"city": "ELLETTSVILLE",
"state": "IN",
"postal_code": "474290062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3671 N LAUREN LN",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474049206",
"telephone_number": "317-508-7823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "NICHOLE",
"middle_name": "A",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-07",
"last_updated": "2024-11-27",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39003462A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.