Provider Information for 1437217791
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JODY NICHOLS L.C.S.W.
Sex: Male
NPI: 1437217791
Last Updated: 2008-02-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1437217791 | ||||||||
| Enumeration Date | 2006-12-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9601 LILE DR SUITE 1050 LITTLE ROCK, AR 72205-6321 United States Phone: 501-228-7400 | Fax:501-537-7412 | ||||||||
| Primary Practice Address | 9601 LILE DR SUITE 1050 LITTLE ROCK, AR 72205-6321 United States Phone: 501-228-7400 | Fax:501-537-7412 | ||||||||
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