Provider Demographics
NPI:1053282459
Name:CONLEY, NICOLLE L (LMHC)
Entity type:Individual
Prefix:MS
First Name:NICOLLE
Middle Name:L
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 JILLOTUS ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5245
Mailing Address - Country:US
Mailing Address - Phone:916-205-5377
Mailing Address - Fax:
Practice Address - Street 1:563 JILLOTUS ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5245
Practice Address - Country:US
Practice Address - Phone:916-205-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health