MEDICARE: GARRETT NICHOLS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184097396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT NICHOLS

Provider Business Mailing Address
First Line	:	2331 YELLOW PAGE RD
Second Line	:
City	:	RATLIFF CITY
State	:	OK
Zip	:	73481-8241
Country	:	US
Telephone Number	:	580-222-6156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 K ST NW
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1801
Country	:	US
Telephone Number	:	580-798-4529
Fax Number	:	580-319-5349

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	11/10/2015

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Directions to “ GARRETT NICHOLS ” Practice Location

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