Provider Demographics
NPI:1558731000
Name:MARK, NICOLE DAWN (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DAWN
Last Name:MARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DAWN
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2548 E KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6712
Mailing Address - Country:US
Mailing Address - Phone:918-810-3449
Mailing Address - Fax:
Practice Address - Street 1:2548 E KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6712
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:918-337-8099
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1386079648OtherNPI