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Individual
MARY-BETH NICKEL
Active
Individual
MARY-BETH NICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C, M.A., D.V.M.
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C2151
OR
101YM0800X
Mental Health Counselor
RR0502
OR
174M00000X
Veterinarian
4404
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123190
—
OR
Enumeration date
08/09/2007
Last updated
08/09/2019
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