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Mike Lyle Nicholson

Social Worker

Behavioral Health & Social Service Providers

1616 Cornwall Ave Ste 205, Bellingham, WA 98225

PECOS Enrollment

This provider is enrolled in PECOS as MIKE NICHOLSON.

Based on the most recent information from CMS, provider Mike Lyle Nicholson is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1184808701
Provider Type
Individual
Full Name
Nicholson, Mike Lyle
Credential
B.S.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
12/18/2007
Last Updated
8/8/2018

Contact Information

Practice Location

1616 Cornwall Ave Ste 205, Bellingham, WA 98225

(360) 676-6177

Unlisted Fax

Mailing Location

1616 Cornwall Ave Ste 205, Bellingham, WA 98225-4642

(360) 676-6177

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License LW60717124 Washington
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License LW60717124 Washington
Code 104100000X	Description Social Worker Behavioral Health & Social Service Providers	License LW60717124 Washington

Mike Lyle Nicholson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Deraas, Corie

Leedom, Erin

Eolande, Brooke

Erika Bronstein M S W P S

Graham, Geneva Elizabeth

Vesper, Joann Marie

Katz, Marjorie Davida

Williams Gieger, Elizabeth Ann

Bellingham Therapeutic Counseling

Zander, Jennifer Gail