Provider Demographics
NPI:1487801882
Name:NUCKOLLS, JILL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:NUCKOLLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4055
Mailing Address - Country:US
Mailing Address - Phone:918-492-8200
Mailing Address - Fax:918-493-3268
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:SUITE 555
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-631-4567
Practice Address - Fax:405-996-2113
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical