Individual
MR. TIMOTHY MATTHEW NIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.H.R.
Contact information
Practice address
39995 RND. MT LN, HOWE, OK 74940
(918) 658-5026
Mailing address
PO BOX 13, POTEAU, OK 74953-0013
(918) 658-5026
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
959
OK
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100731330-A
—
OK
Enumeration date
05/18/2010
Last updated
12/28/2012
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