MR. BRUCE CHARLES NICKLES (NPI# 1174014252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174014252 |
| Entity Type | Individual |
| Full Name | MR. BRUCE CHARLES NICKLES |
| Credential | MFT |
| Practice Address |
151 W Mission St San Jose CA 95110-1713 |
| Mailing Address |
Po Box 110681 Campbell CA 95011-0681 |
| Practice Telephone | 4085354255 |
| Mailing Telephone | 4085931688 |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2018-05-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 39460 | CA | Behavioral Health & Social Service Providers |
| Street Address |
151 W MISSION ST |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95110-1713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487785549 | Marian Lamon | Rehabilitation Counselor | 151 W Mission St, San Jose, CA 95110-1713 | 2007-03-08 |
| 1235754698 | Michael Wong | Pharmacist | 151 W Mission St, San Jose, CA 95110-1713 | 2020-06-11 |
| 1831745892 | Briana Mcalister | Social Worker | 151 W Mission St, San Jose, CA 95110-1713 | 2019-08-15 |
| 1396248480 | Horizon Services, Incorporated | Community/Behavioral Health | 151 W Mission St, San Jose, CA 95110-1713 | 2018-03-14 |
| 1710429535 | County of Santa Clara | Community/Behavioral Health | 151 W Mission St, Ste A1 Wing A, San Jose, CA 95110-1713 | 2016-11-10 |
| 1225481427 | Michael Parker | Rehabilitation Counselor | 151 W Mission St, San Jose, CA 95110-1713 | 2016-07-22 |
| 1093161689 | Ryan Forward | Peer Specialist | 151 W Mission St, Suite 100, San Jose, CA 95110-1713 | 2016-05-12 |
| 1073973582 | Reilly Johnson | Counselor | 151 W Mission St, 100, San Jose, CA 95110-1713 | 2016-02-25 |
| 1801291356 | County of Santa Clara | Community/Behavioral Health | 151 W Mission St, A1 Wing-east, San Jose, CA 95110-1713 | 2014-10-27 |
| 1932509064 | Virginia Ballantyne | Social Worker | 151 W Mission St, San Jose, CA 95110-1713 | 2014-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356876064 | Clarissa Sherrill Chan | Physician Assistant | 685 Coleman Ave Ste 20, San Jose, CA 95110 | 2017-05-01 |
| 1366895666 | Lifemoves - Autumn Satellite Clinic | Case Management | 263 N Autumn St, San Jose, CA 95110 | 2016-07-21 |
| 1487067278 | Catholic Charities of Scc | Community/Behavioral Health | 921 S 1st St, San Jose, CA 95110 | 2014-06-09 |
| 1871855916 | Act for Mental Health, Inc | Psychologist | 441 Park Avenue, San Jose, CA 95110 | 2012-06-14 |
| 1730451238 | Jackson Huang | Nurse Practitioner | 685 Coleman Ave, San Jose, CA 95110 | 2012-01-31 |
| 1104000405 | Kaitlyn Brownell | Case Manager/Care Coordinator | 150-a S. Autumn St., San Jose, CA 95110 | 2007-12-21 |
| 1760685218 | Sharon Iwen Wang | Psychologist | 2033 Gateway Pl Fl 5, San Jose, CA 95110 | 2007-06-11 |
| 1528192036 | Wanda Broadie Alexander | Social Worker | 441 Park Ave, San Jose, CA 95110 | 2007-03-15 |
| 1750442208 | Mario Ricardo Ponce | Counselor | 70 West Hedding Street, County of Santa Clara, San Jose, CA 95110 | 2006-12-12 |
| 1467426882 | Lannie S. Zarate-reyes D.d.s., Inc. | Dentist | 579-10 Coleman Avenue, San Jose, CA 95110 | 2006-02-14 |
| Find all providers in zip 95110 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598372377 | Ratzburg Family Counseling Corporation | Marriage & Family Therapist | 465 Chinook Ln, San Jose, CA 95123-3311 | 2020-09-25 |
| 1285245431 | Carmen J. Frank | Marriage & Family Therapist | 913 Willow St., Suite 103, San Jose, CA 95125 | 2020-08-12 |
| 1083230981 | Joanna Leigh Carson-young | Marriage & Family Therapist | 1769 Park Ave Ste 220, San Jose, CA 95126-2025 | 2020-06-17 |
| 1144857467 | Glenn M Tanimura | Marriage & Family Therapist | 1079 Noble Ln, San Jose, CA 95132-3128 | 2020-03-25 |
| 1265067185 | Of Two Minds Psychotherapy | Marriage & Family Therapist | 190 S. Bascom Ave, Ste 130, San Jose, CA 95128 | 2020-03-11 |
| 1992339196 | Brenda Ann Farrell | Marriage & Family Therapist | 1625 The Alameda Ste 711, San Jose, CA 95126-2225 | 2020-02-26 |
| 1619507472 | Michelle Marie Wambach | Marriage & Family Therapist | 4020 Moorpark Ave Ste 206, San Jose, CA 95117-1846 | 2020-01-21 |
| 1699313080 | Juan Carlos Mercado | Marriage & Family Therapist | 290 North 2nd St, San Jose, CA 95112 | 2019-12-16 |
| 1497398002 | Veronica Marie Ayala | Marriage & Family Therapist | 840 Guadalupe Pkwy Fl 2, San Jose, CA 95110-1714 | 2019-10-26 |
| 1700428224 | Lynn Huggins | Marriage & Family Therapist | 1625 The Alameda Ste 304, San Jose, CA 95126-2223 | 2019-10-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.