Provider Demographics
NPI:1780261651
Name:NIMSEY, HELEN PEARL NASHOBA MALANTA
Entity type:Individual
Prefix:
First Name:HELEN PEARL
Middle Name:NASHOBA MALANTA
Last Name:NIMSEY
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 1:265 WICHITA DR
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-3705
Mailing Address - Country:US
Mailing Address - Phone:405-933-0043
Mailing Address - Fax:
Practice Address - Street 1:265 WICHITA DR
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-3705
Practice Address - Country:US
Practice Address - Phone:405-933-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10184101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10184OtherOKLAHOMA STATE BOARD OF BEHAVIORAL HEALTH