Active NPI
Amy Rebecca Nichols, LPC
- Professional Counselor
- Dallas, TX
National Provider Identifier
1558596304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 64110
- Practice address
- 4701 Samuell Blvd
Dallas, TX 75228-6828 - Phone
- (214) 381-7070
- NPI assigned
- May 22, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 64110 | TX | Primary |
Addresses
Primary practice location
4701 Samuell Blvd
Dallas, TX 75228-6828
Mailing address
4701 Samuell Blvd
Dallas, TX 75228-6828
Phone (214) 381-7070
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 |
|---|---|---|---|
| 64110 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dallas County Mental Health & Mental Retardation 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.
-
- Psychiatry Physician
- Dallas, TX
- NPI 1023239886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242950400000",
"number": "1558596304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 SAMUELL BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752286828",
"telephone_number": "214-381-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 SAMUELL BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752286828",
"telephone_number": "214-381-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "AMY",
"middle_name": "REBECCA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-22",
"last_updated": "2009-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "64110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.