Desirae Layne Nicks, CG60864058

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CG60864058 Issued in WA

Practice address

3901 S Fife St Ste 301
Tacoma, WA 98409-7309

Phone

(253) 625-4422

Fax

(253) 584-1496

NPI assigned

Dec 17, 2018

Last updated

Dec 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1639641590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 S FIFE ST STE 301",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097309",
            "telephone_number": "253-625-4422",
            "fax_number": "253-584-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 S FIFE ST STE 301",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097309",
            "telephone_number": "253-625-4422",
            "fax_number": "253-584-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKS",
        "first_name": "DESIRAE",
        "middle_name": "LAYNE",
        "credential": "CG60864058",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG60864058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CG60864058",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Todd Nickel, DO
• Gary Wayne Nickel, M.D.
• Madelyn Morgan Nickell
• Shilah Nickerson
• Dystiny D Nickle
• Rodney Nicolas, PHARM.D.
• Nicole M. Ancich, DMD PLLC
• Alex Nicoud
• Michael Niebergall
• Katie Jean Niehl, AU.D.

• Mental Health Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.