Basic Information
| Provider Information | |||||||||
| NPI: | 1821443466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAGLE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | SANDRA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19128 112TH AVE NE # 2-439 | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980110008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252869973 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21907 64TH AVE W STE 200 | ||||||||
| Address2: | |||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980436200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256407009 | ||||||||
| FaxNumber: | 4256409600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2016 | ||||||||
| LastUpdateDate: | 06/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC61226396 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.