DESIRAE LAYNE NICKS CG60864058 NPI 1639641590

NPI Information

NPI: 1639641590
Provider Name: DESIRAE LAYNE NICKS, CG60864058
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
3901 S FIFE ST STE 301
TACOMA, WA
ZIP 98409
Phone: (253) 625-4422
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Desirae Layne Nicks, CG60864058 is a mental health counselor in Tacoma, WA. Desirae Layne Nicks, CG60864058 NPI is 1639641590. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3901 S FIFE ST STE 301
TACOMA, WA
ZIP 98409-309
Phone: (253) 625-4422
Fax: (253) 584-1496

The enumeration date for this NPI number is 12/17/2018 and was last updated on 12/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	CG60864058	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CG60864058	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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