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General NPI Number Information
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NPI Number | 1538495692
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Entity Type | Individual
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Provider Name | MARTI LEEANN NICHOLS LBHP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 56577 COUNTY ROAD 660
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City | COLCORD
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State | OK
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Zip | 74338-2520
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Country | US
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Telephone | 918-864-0353
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Fax |
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Provider Business Mailing Address
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Address Line | 56577 COUNTY ROAD 660
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City | COLCORD
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State | OK
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Zip | 74338-2520
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Country | US
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Telephone | 918-864-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1274
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License Number State | OK
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