Provider Demographics
NPI:1265877211
Name:BAUMAN, NICOLE DANIEL (LPC UNDER SUPERVISIO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIEL
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:LPC UNDER SUPERVISIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:ALEX
Mailing Address - State:OK
Mailing Address - Zip Code:73002-0454
Mailing Address - Country:US
Mailing Address - Phone:405-320-0561
Mailing Address - Fax:
Practice Address - Street 1:198 E ALMAR DR
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-7327
Practice Address - Country:US
Practice Address - Phone:405-222-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program