Individual
NICOLE IDLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
109 SOUTH 1ST, MADILL, OK 73446
(580) 795-3731
(580) 795-3170
Mailing address
6008 RECK RD., WILSON, OK 73463
(580) 668-1109
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
06/10/2011
Last updated
06/10/2011
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