Provider Demographics
NPI:1578914768
Name:NICHOLS, KATHRYN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3826 NW EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4946
Mailing Address - Country:US
Mailing Address - Phone:580-514-8826
Mailing Address - Fax:
Practice Address - Street 1:1815 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3614
Practice Address - Country:US
Practice Address - Phone:580-514-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health