| Doctor Name: | NICOLE IDLEMAN |
| NPI Number: | 1376838086 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 109 South 1st Madill, OK - 73446 |
| Business Phone Number: | 5807953731 |
| Business Fax Number: | 5807953170 |
| Mailing Address: | 6008 Reck Rd., WILSON |
| State: | OK |
| Postal Code: | 73463 |
| Phone Number: | 5806681109 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2011 |
| NPI Last Update Date: | 06/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |