Individual
RILEY NICKOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
231 W LOCKWOOD AVE, SUITE 201, SAINT LOUIS, MO 63119-2951
(314) 968-1900
Mailing address
16 N GORE AVE STE 204, SAINT LOUIS, MO 63119-2315
(513) 505-2160
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2013032493
MO
Other
Enumeration date
09/25/2009
Last updated
04/21/2020
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