Most Relevant Information
Provider Data
| NPI Number: | 1003813957 |
| Provider Name: | TERESA J NICHOLS LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 20002007253 |
Most Important Dates
| Enumeration Date: | 07/07/2005 |
| Last Updated: | 04/20/2012 |
Provider Practice Location
421 LINE STREET
NEW MADRID
MO
638691733
Practice Location Phone/Fax
| Phone: | 5737482592 |
| Fax: | 5737482291 |
Provider Mailing Location
PO BOX 128
BLODGETT
MO
638240128
Provider Mailing Phone/Fax
| Phone: | 5737036667 |
| Fax: | 5737482291 |