Individual ProviderNicole SmithCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553(503) 258-4200PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1972019776Provider TypeIndividualFull NameSmith, NicoleGenderFemaleSole ProprietorYesEnumeration Date12/17/2017Last Updated12/17/2017Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer