Autumn Nickelson

NPI #1619142767 in Woodward, Oklahoma

Provider Information

NPI Number: 1619142767
Entity Type: Individual
Name: Autumn Nickelson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker - Clinical
Enumeration Date: Apr 29, 2008
Last Updated: Nov 30, 2016

Practice Location

Address: 1222 10TH STREET, SUITE 211
Address 2: NORTHWEST CENTER FOR BEHAVIORAL HEALTH
City: Woodward
State: Oklahoma
ZIP Code: 73801
Phone: (580) 571-3231

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary
Marriage & Family Therapist	106H00000X

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