Individual
EMMA D NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, HSPP
Contact information
Practice address
7300 E INDIANA ST, STE 103, EVANSVILLE, IN 47715-2794
(812) 401-8008
(812) 401-8201
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041775
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000256887
ANTHEM
IN
05
—
200411690
—
IN
Enumeration date
11/30/2006
Last updated
07/07/2011
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