Individual
MARTI LEEANN NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBHP
Contact information
Practice address
56577 COUNTY ROAD 660, COLCORD, OK 74338-2520
(918) 864-0353
Mailing address
56577 COUNTY ROAD 660, COLCORD, OK 74338-2520
(918) 864-0353
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1274
OK
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
OK
103TR0400X
Rehabilitation Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200375130A
—
OK
Enumeration date
10/26/2009
Last updated
11/11/2025
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