Individual
MRS. BONNIE NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
860 S ASPEN AVE, BROKEN ARROW, OK 74012-4803
(918) 258-6545
Mailing address
25547 MURPHY CT, CLAREMORE, OK 74019-4503
(918) 706-1038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6486
OK
Other
Enumeration date
10/08/2018
Last updated
10/08/2018
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