Provider Demographics
NPI:1962074112
Name:NICHOLS, CHRISTOPHER DANIEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S XANTHUS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-1420
Mailing Address - Country:US
Mailing Address - Phone:918-960-1179
Mailing Address - Fax:
Practice Address - Street 1:6130 E 32ND ST STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5454
Practice Address - Country:US
Practice Address - Phone:918-402-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical