Provider Demographics
NPI:1639053366
Name:NICHOLSON, PATRICK HENRY JR
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HENRY
Last Name:NICHOLSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 11TH AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-2082
Mailing Address - Country:US
Mailing Address - Phone:253-219-2081
Mailing Address - Fax:
Practice Address - Street 1:14202 11TH AVENUE CT S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-2082
Practice Address - Country:US
Practice Address - Phone:253-219-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health