Nicole Michelle Ilacqua, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

69575 Issued in TX

Practice address

2323 Timber Shadows Dr
Kingwood, TX 77339-2028

Phone

(832) 233-3086

NPI assigned

Jul 8, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Nicole Michelle Neiman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Kbccms, LLC

  • Professional Counselor
  • Oxford, MS
  • NPI 1841899978
  NPD (past)

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1902118797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 TIMBER SHADOWS DR STE B",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 TIMBER SHADOWS DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392028",
            "telephone_number": "832-233-3086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 North Loop W",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770188124",
            "country_code": "US",
            "telephone_number": "832-413-2410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILACQUA",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "69575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "NEIMAN",
            "middle_name": "MICHELLE",
            "prefix": "MISS",
            "credential": "PCC-S LICDC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Kingwood, TX
• Providers in Kingwood, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.