| Kelly L Nicholson, Psyd | |
|
19 Shelter Cove Ln Hilton Head Island SC 29928-3520 | |
| (843) 226-6690 | |
| Not Available |
| Full Name | Kelly L Nicholson, Psyd |
|---|---|
| Speciality | Psychologist |
| Location | 19 Shelter Cove Ln, Hilton Head Island, South Carolina |
| Authorized Official Name and Position | Kelly L Nicholson (PSYCHOLOGIST) |
| Authorized Official Contact | 8432266690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly L Nicholson, Psyd 22 Redbud Way Bluffton SC 29910-5605 Ph: (843) 226-6690 | Kelly L Nicholson, Psyd 19 Shelter Cove Ln Hilton Head Island SC 29928-3520 Ph: (843) 226-6690 |
| NPI Number | 1285001560 |
|---|---|
| Provider Enumeration Date | 08/21/2015 |
| Last Update Date | 08/21/2015 |
| Medicare PECOS PAC ID | 0547576357 |
|---|---|
| Medicare Enrollment ID | O20150824002308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285001560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1340 (South Carolina) | Primary |
| Provider Name | Kelly L Nicholson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043424807 PECOS PAC ID: 9931239191 Enrollment ID: I20150302001596 |
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