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Autumn Nickelson

NPI 1619142767 · on the registry since 2008 · sole proprietor

Practice

Address
1222 10th Street, Suite 211
Northwest Center For Behavioral Health
Woodward, OK 73801
Phone
(580) 571-3231
Fax
(580) 571-8609
Organisation at this address
State Of Oklahoma
Grand Lake Mental Health Center, Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address
106

Registry record

Primary taxonomy
1041C0700X
1041C0700X
Also registered as
106H00000X
Licence states on file
OK
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2016-11-30

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma