Jody Nichols

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CIT-5033 Issued in LA

Practice address

806 Carter St
Vidalia, LA 71373-3206

Phone

(318) 734-0034

Fax

(601) 493-5898

NPI assigned

Sep 20, 2019

Last updated

Feb 4, 2021By the provider in NPPES

Sex

Male

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Easy Living Behavioral Health

  • Community/Behavioral Health Agency
  • Vidalia, LA
  • NPI 1780191486
  NPD

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1679124739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 CARTER ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733206",
            "telephone_number": "318-734-0034",
            "fax_number": "601-493-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 CARTER ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733206",
            "telephone_number": "318-734-0034",
            "fax_number": "601-493-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JODY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-20",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "CIT-5033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF LOUISIANA ADDICTIVE DISORDER REGULATORY AUTHORITY",
            "identifier": "5033",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natchez Regional Clinic
• Vickey Neal
• Mary Laskeisha Nelson, NCC
• Ekaternia Neveykina
• Riccardo Newell
• Lisa Nichols
• Northland Hearing Centers, Inc. (Audibel Hearing Healthcare)
• Lacey Ozburn, DPT
• Tiffany M Paul
• Pediatric & Adolescent Clinic of Louisiana LLC

• Addiction (Substance Use Disorder) Counselor in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Addiction (Substance Use Disorder) Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.