Organization
NICOLET COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD NICOLET (OWNER)
(260) 436-5815
Entity
Organization
Contact information
Practice address
5709 LIBERTY CT, FORT WAYNE, IN 46804-4335
(260) 436-5815
Mailing address
5709 LIBERTY CT, FORT WAYNE, IN 46804-4335
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000094A
IN
101YM0800X
Mental Health Counselor
Primary
39001898A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1
—
IN
Enumeration date
06/14/2011
Last updated
06/14/2011
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