MEDICARE: NICOLE MONEE SOMMERSVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT.0002101	CO
2	106H00000X	Marriage & Family Therapist	MT3906	FL
3	106H00000X	Marriage & Family Therapist	10129	OK

General Provider Information

NPI Number	:	1548935067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MONEE SOMMERSVILLE

Provider Business Mailing Address
First Line	:	7521 S OLYMPIA AVE # 1032
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1855
Country	:	US
Telephone Number	:	918-816-8863
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 S OLYMPIA AVE
Second Line	:	# 1032
City	:	TULSA
State	:	OK
Zip	:	74132-1855
Country	:	US
Telephone Number	:	918-816-8863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	02/14/2022

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Directions to “ NICOLE MONEE SOMMERSVILLE ” Practice Location

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