Provider Demographics
NPI:1235952102
Name:LOUNSBERY, NICOLE B (MA, LPC, PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:LOUNSBERY
Suffix:
Gender:F
Credentials:MA, LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 PAMELA DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-5129
Mailing Address - Country:US
Mailing Address - Phone:605-695-4169
Mailing Address - Fax:
Practice Address - Street 1:601 4TH ST STE 111
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2065
Practice Address - Country:US
Practice Address - Phone:605-620-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional