MEDICARE: NUBIA FIESEL, LPC, PLLC

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	:	1962999631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUBIA FIESEL, LPC, PLLC

Provider Business Mailing Address
First Line	:	3131 SW 89TH ST APT 11211
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7944
Country	:	US
Telephone Number	:	405-210-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-2408
Country	:	US
Telephone Number	:	405-210-1100
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIORAL HEALTH THERAPIST
Name	:	NUBIA FIESEL
Credential	:	LPC
Telephone Number	:	405-210-1100

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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