Provider Demographics
NPI:1841633252
Name:NICHOLS, RONALD WENDELL JR
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WENDELL
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N TELA DR
Mailing Address - Street 2:APT 21
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-4373
Mailing Address - Country:US
Mailing Address - Phone:405-881-2127
Mailing Address - Fax:405-949-0929
Practice Address - Street 1:1120 N TELA DR
Practice Address - Street 2:APT 21
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-4373
Practice Address - Country:US
Practice Address - Phone:405-881-2127
Practice Address - Fax:405-949-0929
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)