Provider Demographics
NPI:1700504503
Name:ST. CLAIR-CHARLES, NICIA
Entity Type:Individual
Prefix:
First Name:NICIA
Middle Name:
Last Name:ST. CLAIR-CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S SHERIDAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7524
Mailing Address - Country:US
Mailing Address - Phone:918-908-9353
Mailing Address - Fax:
Practice Address - Street 1:433 S TROOST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3421
Practice Address - Country:US
Practice Address - Phone:918-933-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst