Individual
NICOLE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10700 US 169, OOLOGAH, OK 74080
(918) 798-1062
Mailing address
1402 N FLORENCE AVE, CLAREMORE, OK 74017-3159
(918) 615-9472
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
OK
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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