Provider Demographics
NPI:1912644618
Name:RICHERT, NICHOLAS (LMSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RICHERT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2217 WHEATHEART DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5060
Mailing Address - Country:US
Mailing Address - Phone:405-694-8089
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 709
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4537
Practice Address - Country:US
Practice Address - Phone:405-694-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical