Individual
NICHOLE D GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC, LADC/MH
Contact information
Practice address
1442 E OAK ST, CUSHING, OK 74023-3644
(918) 285-0947
(918) 376-0170
Mailing address
1442 E OAK ST, CUSHING, OK 74023-3644
(918) 285-0947
(918) 376-0170
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1065
OK
101Y00000X
Counselor
Primary
5025
OK
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200350220C
—
OK
Enumeration date
06/13/2011
Last updated
04/28/2022
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