MEDICARE: NAKISIA MONIQUE CHENEVERT CM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	4742	OK
3	101Y00000X	Counselor	4742	OK

General Provider Information

NPI Number	:	1871744326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKISIA MONIQUE CHENEVERT CM

Provider Business Mailing Address
First Line	:	5505 MAIN ST STE 100
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5508
Country	:	US
Telephone Number	:	405-812-0642
Fax Number	:	405-812-0642

Provider Business Practice Location Address
First Line	:	5505 MAIN ST STE 100
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5508
Country	:	US
Telephone Number	:	405-812-0642
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	08/15/2024

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