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General NPI Number Information
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NPI Number | 1558731000
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Entity Type | Individual
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Provider Name | NICOLE MARK LMFT, MA
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Gender | Female
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 7320 S YALE AVE STE B
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City | TULSA
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State | OK
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Zip | 74136-7034
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Country | US
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Telephone | 918-992-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 2548 E KENOSHA ST
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City | BROKEN ARROW
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State | OK
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Zip | 74014-6712
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Country | US
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Telephone | 918-810-3449
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT01234
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License Number State | OK
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