Provider Demographics
NPI:1447847553
Name:NICKS-IRVINE, JULIE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:NICKS-IRVINE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:HIDDEN BRIDGES
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1949 SUGARLAND DR STE 122
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-429-0644
Mailing Address - Fax:307-675-4920
Practice Address - Street 1:1949 SUGARLAND DR STE 122
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-429-0644
Practice Address - Fax:307-675-4920
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional