Individual
AUTUMN NICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1222 10TH STREET, SUITE 211, NORTHWEST CENTER FOR BEHAVIORAL HEALTH, WOODWARD, OK 73801
(580) 571-3231
(580) 571-8609
Mailing address
1222 10TH STREET, SUITE 211, NORTHWEST CENTER FOR BEHAVIORAL HEALTH, WOODWARD, OK 73801
(580) 571-3231
(580) 571-8609
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3847
OK
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200407870
—
OK
Enumeration date
04/29/2008
Last updated
11/30/2016
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