Active NPI
David Niclas, LMHC
- Mental Health Counselor
- Albuquerque, NM
National Provider Identifier
1508232380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- T-0174521
- Practice address
- 6611 Gulton CT NE
Albuquerque, NM 87109-4407 - Phone
- (505) 296-3965
- NPI assigned
- Aug 17, 2015
- Sex
- Male
- Sole proprietor
- No
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 | T-0174521 | NM | Primary |
Addresses
Primary practice location
6611 Gulton CT NE
Albuquerque, NM 87109-4407
Mailing address
1773 Avenida Bonita NW
Los Lunas, NM 87031-8369
Phone (505) 340-8324
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-0174521 | NM | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Treatment Center | 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.
-
- Mental Illness Community Based Residential Treatment Facility
- Albuquerque, NM
- NPI 1750370847
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1508232380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1773 AVENIDA BONITA NW",
"city": "LOS LUNAS",
"state": "NM",
"postal_code": "870318369",
"telephone_number": "505-340-8324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6611 GULTON CT NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094407",
"telephone_number": "505-296-3965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICLAS",
"first_name": "DAVID",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-17",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "T-0174521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.