Individual
NICOLAS MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6111 E SKELLY DR, TULSA, OK 74135-6100
(844) 458-2100
Mailing address
1860 E 16TH ST, TULSA, OK 74104-4903
(786) 872-3231
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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