Provider Demographics
NPI:1205166485
Name:MENTZER, NICHOLE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:MENTZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8221
Mailing Address - Country:US
Mailing Address - Phone:405-201-0620
Mailing Address - Fax:
Practice Address - Street 1:2817 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8221
Practice Address - Country:US
Practice Address - Phone:405-201-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker