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NPI Code Detail

MEDICARE: MR. KEVIN THOMAS NIEMAN PH.D.

MEDICARE: MR. KEVIN THOMAS NIEMAN PH.D.
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
1106H00000XMarriage & Family Therapist1015OK

General Provider Information

NPI Number : 1831245794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN THOMAS NIEMAN PH.D.
Provider Business Mailing Address
First Line : 4930 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5712
Country : US
Telephone Number : 918-392-4008
Fax Number : 918-392-4009
Provider Business Practice Location Address
First Line : 4930 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5712
Country : US
Telephone Number : 918-392-4008
Fax Number : 918-392-4009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 08/31/2011

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