| Molly Louise Nicholson | |
|
3507 Lyndale Ave S Minneapolis MN 55408-4159 | |
| (612) 702-4119 | |
| (612) 208-0774 |
| Full Name | Molly Louise Nicholson |
|---|---|
| Speciality | Counselor |
| Location | 3507 Lyndale Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Molly L Nicholson (OWNER) |
| Authorized Official Contact | 6127024119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Molly Louise Nicholson 3507 Lyndale Ave S Minneapolis MN 55408-4159 Ph: (612) 702-4119 | Molly Louise Nicholson 3507 Lyndale Ave S Minneapolis MN 55408-4159 Ph: (612) 702-4119 |
| NPI Number | 1821852856 |
|---|---|
| Provider Enumeration Date | 02/09/2024 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 4486095189 |
|---|---|
| Medicare Enrollment ID | O20240513001808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821852856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Molly Louise Nicholson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487920013 PECOS PAC ID: 6608219639 Enrollment ID: I20240513001933 |
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