Provider Demographics
NPI:1902116650
Name:CRITES, NICOLE LEANN (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEANN
Last Name:CRITES
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951
Mailing Address - Country:US
Mailing Address - Phone:620-544-4357
Mailing Address - Fax:620-598-2011
Practice Address - Street 1:606 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2429
Practice Address - Country:US
Practice Address - Phone:620-544-4357
Practice Address - Fax:620-598-2011
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist