Individual
MR. JACKSON TATE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E LOUCKS ST # 3014, SHERIDAN, WY 82801-9998
(307) 752-3463
(307) 752-3463
Mailing address
101 E LOUCKS ST # 3014, SHERIDAN, WY 82801-9998
(307) 752-3463
(307) 752-3463
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
PCSW-1274
WY
Other
Enumeration date
11/07/2025
Last updated
11/07/2025
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