Healthcare Provider Details

I. General information

NPI: 1174716393
Provider Name (Legal Business Name): SHARON NICHOLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 S SHERIDAN RD SUITE D
TULSA OK
74133-4056
US

IV. Provider business mailing address

6262 S SHERIDAN RD
TULSA OK
74133-4055
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-3083
  • Fax: 918-495-3713
Mailing address:
  • Phone: 918-492-8200
  • Fax: 918-493-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3798
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: