Provider Demographics
NPI:1780739458
Name:WATSON, NICOLE A (MHR, LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N CLASSEN BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2670
Mailing Address - Country:US
Mailing Address - Phone:405-231-3150
Mailing Address - Fax:405-231-3157
Practice Address - Street 1:4001 N CLASSEN BLVD STE 225
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2670
Practice Address - Country:US
Practice Address - Phone:405-231-3150
Practice Address - Fax:405-231-3157
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional