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Contact Information

AUTUMN NICKELSON
1222 10TH STREET, SUITE 211
NORTHWEST CENTER FOR BEHAVIORAL HEALTH
WOODWARD, OK73801
 Phone: 580-571-3231
 Fax: 580-571-8609
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Marriage & Family Therapist

106H00000X
Indicates primary specialty

NPI Profile & details for AUTUMN NICKELSON · (Female)

NPI # 1619142767
Status Active
Credentials
Entity Individual
Enumeration date 04/29/2008
Last updated 11/30/2016 - About 10 years ago
Sole proprietor 1 Yes
Identifiers
  • OK License # 3847
  • OK Medicaid 200407870
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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