Individual
MR. MICHAEL NICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
VRC, CRC, LCPC
Contact information
Practice address
EDWARD HINES JR. VA HOSPITAL, VRS(MC:116A7), 5000 S. 5TH AVE., HINES, IL 60141
(708) 202-2530
Mailing address
6930 S HONORE ST, CHICAGO, IL 60636-3234
(773) 653-1152
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
180.007568
IL
101YP2500X
Professional Counselor
180.007568
IL
225C00000X
Rehabilitation Counselor
Primary
65571
—
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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