Organization
NICKLES PRIVATE PROBATION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH LEE NICKLES JR. (SOLE MEMBER)
(573) 712-5145
Entity
Organization
Contact information
Practice address
205 3RD ST, STEELVILLE, MO 65565-5054
(573) 712-5145
(630) 305-9287
Mailing address
PO BOX 1325, STEELVILLE, MO 65565-1325
(573) 712-5145
(630) 604-9287
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
06/07/2024
Last updated
06/07/2024
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