Jae Nicholson

NPI #1619620176 in Bryan, Texas

Provider Information

NPI Number: 1619620176
Entity Type: Individual
Name: Jae Nicholson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Professional
Enumeration Date: Feb 3, 2022
Last Updated: Feb 3, 2022

Practice Location

Address: 2490 BOONVILLE RD
City: Bryan
State: Texas
ZIP Code: 77808-2326
Phone: (979) 703-1808

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X	Primary

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