Individual
MR. KASEY JOSEPH NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., LAC
Contact information
Practice address
830 W CENTRAL AVE, MISSOULA, MT 59801-7931
(406) 829-9515
(406) 829-9519
Mailing address
830 W CENTRAL AVE, MISSOULA, MT 59801-7931
(406) 829-9515
(406) 829-9519
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1340 LAC
MT
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
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