Healthcare Provider Details

I. General information

NPI: 1336801877
Provider Name (Legal Business Name): NICHOLE BEAR LADC/MH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S BELMONT AVE STE 106
OKMULGEE OK
74447-6315
US

IV. Provider business mailing address

PO BOX 143
JENKS OK
74037-0143
US

V. Phone/Fax

Practice location:
  • Phone: 918-758-1910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: