Individual
MRS. JEAN MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2650 KOOS BAY BLVD, COOS BAY, OR 97420-2579
(541) 294-7001
Mailing address
1610 JOHNSON ST, NORTH BEND, OR 97459-1936
(541) 217-1514
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
OR
171M00000X
Case Manager/Care Coordinator
—
OR
175T00000X
Peer Specialist
23-CRM-II-0086
OR
Other
Enumeration date
01/28/2016
Last updated
06/22/2023
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