Active NPI
Cynthia Nichols, PHD
- Clinical Psychologist
- Traverse City, MI
National Provider Identifier
1588794069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301008026
- Practice address
- 550 Munson Ave
Ste. 201
Traverse City, MI 49686-3580 - Phone
- (231) 935-9307
- Fax
- (231) 935-9300
- NPI assigned
- Mar 6, 2007
- Last updated
- Oct 31, 2018
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301008026 | MI | Primary |
Addresses
Primary practice location
550 Munson Ave
Ste. 201
Traverse City, MI 49686-3580
Mailing address
550 Munson Ave
Ste. 201
Traverse City, MI 49686-3580
Phone (231) 935-9307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CN008026 | Other | MI | BLUE CROSS |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540944000000",
"number": "1588794069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 MUNSON AVE",
"address_2": "STE. 201",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863580",
"telephone_number": "231-935-9307",
"fax_number": "231-935-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 MUNSON AVE",
"address_2": "STE. 201",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863580",
"telephone_number": "231-935-9307",
"fax_number": "231-935-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "CYNTHIA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2018-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301008026",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "CN008026",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.