| Doctor Name: | KRISTAL SHELLEY NICHOLSON |
| NPI Number: | 1083919104 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 1768 |
| Business Practice Address: | 5840 S Memorial Dr Suite No. 3003 Tulsa, OK - 741459023 |
| Business Phone Number: | 9186713392 |
| Business Fax Number: | 4134311359 |
| Mailing Address: | 5116 E 27th Pl, TULSA |
| State: | OK |
| Postal Code: | 741144912 |
| Phone Number: | 9186713392 |
| Fax Number: | 4134311359 |
| NPI Enumeration Date: | 01/20/2011 |
| NPI Last Update Date: | 02/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 1768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |