| Nicolet Counseling Llc | |
|
5709 Liberty Ct Fort Wayne IN 46804-4335 | |
| (260) 436-5815 | |
| Not Available |
| Full Name | Nicolet Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 5709 Liberty Ct, Fort Wayne, Indiana |
| Authorized Official Name and Position | Ronald Nicolet (OWNER) |
| Authorized Official Contact | 2604365815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicolet Counseling Llc 5709 Liberty Ct Fort Wayne IN 46804-4335 Ph: () - | Nicolet Counseling Llc 5709 Liberty Ct Fort Wayne IN 46804-4335 Ph: (260) 436-5815 |
| NPI Number | 1346535754 |
|---|---|
| Provider Enumeration Date | 06/14/2011 |
| Last Update Date | 06/14/2011 |
| Medicare PECOS PAC ID | 3173799731 |
|---|---|
| Medicare Enrollment ID | O20120103000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346535754 | NPI | - | NPPES |
| 1 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 87000094A (Indiana) | Secondary |
| 101YM0800X | Counselor - Mental Health | 39001898A (Indiana) | Primary |
| Provider Name | Eric Jay Betts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336132679 PECOS PAC ID: 8224014261 Enrollment ID: I20040629000677 |
| Provider Name | Paula A Neuman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144555855 PECOS PAC ID: 5890975148 Enrollment ID: I20110203001066 |
| Provider Name | Ronald Nicolet |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194998179 PECOS PAC ID: 1052587615 Enrollment ID: I20231128002862 |
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