| NPI | 1134510795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PORTIA GOLDSMITH-NICKELBERRY Owner/Operator 405-367-9034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 4889) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2024-12-13 |