Individual
CHRIS NICELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
825 W LINEBAUGH AVE, TAMPA, FL 33612-7855
(813) 421-7158
Mailing address
18303 BIG POND WAY, TAMPA, FL 33647-2432
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH17615
FL
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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