Provider Demographics
NPI:1134891351
Name:SCALF, NICOLE DEETTE (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEETTE
Last Name:SCALF
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:SCALF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11117 NE 189TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6244
Mailing Address - Country:US
Mailing Address - Phone:360-610-7775
Mailing Address - Fax:
Practice Address - Street 1:811 NE 112TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5115
Practice Address - Country:US
Practice Address - Phone:360-553-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61135727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61135727OtherWA STATE DEPARTMENT OF HEALTH