JACKSON TATE NICHOLS

SHERIDAN, WY
NPI1548130255
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: WY  PCSW-1274)
Enumeration Date2025-11-07
Last Update Date2025-11-07
Business Address
Mr. JACKSON TATE NICHOLS
101 E LOUCKS ST # 3014
SHERIDAN, WY 82801-9998
Phone number: 307-752-3463
Mailing Address
Mr. JACKSON TATE NICHOLS
101 E LOUCKS ST # 3014
SHERIDAN, WY 82801-9998
Phone number: 307-752-3463
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