Individual
NICOLE DARLENE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
5904 WARNER AVE UNIT 413, HUNTINGTON BEACH, CA 92649-4670
(909) 898-7886
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2018013675
MO
101YP2500X
Professional Counselor
Primary
16030
CA
101YP2500X
Professional Counselor
37PC00899200
NJ
101YP2500X
Professional Counselor
PC-0011186
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490055189
—
MO
Enumeration date
06/06/2018
Last updated
01/05/2026
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