Active NPI
Bonnie Nicholls, LCSW
- Clinical Social Worker
- Broken Arrow, OK
National Provider Identifier
1891260782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6486
- Practice address
- 860 S Aspen Ave
Broken Arrow, OK 74012-4803 - Phone
- (918) 258-6545
- NPI assigned
- Oct 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6486 | OK | Primary |
Addresses
Primary practice location
860 S Aspen Ave
Broken Arrow, OK 74012-4803
Mailing address
25547 Murphy CT
Claremore, OK 74019-4503
Phone (918) 706-1038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6486 | OK | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538956800000",
"number": "1891260782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25547 MURPHY CT",
"city": "CLAREMORE",
"state": "OK",
"postal_code": "740194503",
"telephone_number": "918-706-1038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 S ASPEN AVE",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740124803",
"telephone_number": "918-258-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLLS",
"first_name": "BONNIE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-08",
"last_updated": "2018-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "6486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.