Mary Lee Nichols PHD LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

949 Issued in OR

Legal business name

MARY LEE NICHOLS PHD LLC

Practice address

1133 NW 21St Ave
Portland, OR 97209-1513

Phone

(503) 277-3868

Fax

(503) 650-1892

NPI assigned

Sep 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy Winslow

Title

Office Manager

Phone

(503) 277-3868

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Nichols

  • Psychologist
  • Portland, OR
  • NPI 1053517110
  NPD (past)

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1861974776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 NW 21ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091513",
            "telephone_number": "503-277-3868",
            "fax_number": "503-650-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 NW 21ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091513",
            "telephone_number": "503-277-3868",
            "fax_number": "503-650-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LEE NICHOLS PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-06",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "WINSLOW",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-277-3868"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "OR",
            "license": "949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.