Provider Demographics
NPI:1447732557
Name:NICK, KATHLEEN (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 PARR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2264
Mailing Address - Country:US
Mailing Address - Phone:317-809-1434
Mailing Address - Fax:
Practice Address - Street 1:10801 N MICHIGAN RD STE 240
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7845
Practice Address - Country:US
Practice Address - Phone:317-809-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000337A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist