Gary Lee Nichols, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

991083 Issued in CO

Practice address

3250 Zemke Ave
Tampa, FL 33621-5023

Phone

(813) 827-9170

Fax

(813) 828-6868

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Alpine Counseling LLC

  • Clinical Social Worker
  • Pueblo, CO
  • NPI 1184650236
  NPD (past) Authorized official

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1477580132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 ZEMKE AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336215023",
            "telephone_number": "813-827-9170",
            "fax_number": "813-828-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 ZEMKE AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336215023",
            "telephone_number": "813-827-9170",
            "fax_number": "813-828-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "991083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035268",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosemarie Nicholas, PA-C
• Marcia Montel Nicholls
• Charles Tiberias Nichols, PT, DPT
• Corinne R Nichols, A.P., D.O.M.
• Dean Lyndon Nichols, LMHC
• Jane Shima Nichols, RN
• Nicole Amber Nichols
• Terrencia Nichols, APRN
• Karen Jane Nicholson, PH.D.
• Lyndsey K Nicholson

• Clinical Social Worker in Tampa, FL
• Providers in Tampa, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; 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.