Provider Demographics
NPI:1235967092
Name:NICKELS, TINA (LPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NICKELS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4809
Mailing Address - Country:US
Mailing Address - Phone:806-485-8100
Mailing Address - Fax:
Practice Address - Street 1:2600 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4809
Practice Address - Country:US
Practice Address - Phone:806-485-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional