Faith N Nicholson

Individual provider Active NPI Peer Specialist · Yucca Valley, CA

NPI 1558008136 · NPPES record last updated May 30, 2024

Key facts

NPI
1558008136
Entity type
Individual (NPI type 1)
Primary specialty
Peer Specialist 175T00000X
Practice address
58471 29 Palms Hwy Ste 102
Yucca Valley, CA 92284-5818
Phone
(760) 853-4888
NPI assigned
May 16, 2022
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MPSS-OVWSLECAMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Star Behavioral Health, Inc. Past
since May 22, 2022
Accepting new patients
Valley Star Behavioral Health, Inc. Past
since May 22, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Community Health Worker 172V00000X
Peer Specialist 175T00000X MPSS-OVWSLE CA
Peer Specialist 175T00000X Yes

Addresses

Primary practice location

58471 29 Palms Hwy Ste 102
Yucca Valley, CA 92284-5818

Mailing address

58471 29 Palms Hwy Ste 102
Yucca Valley, CA 92284-5818
Phone (857) 760-4888

Other names

  • Faith Noel McAllen Former name

Other providers in Yucca Valley, CA

All providers in Yucca Valley, CA · Peer Specialist in California

Sources for this page

Verify at the official NPI Registry.