Basic Information
| Provider Information | |||||||||
| NPI: | 1962763318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEMAN | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT LD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4930 S SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741455712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183924008 | ||||||||
| FaxNumber: | 9183924009 | ||||||||
| Practice Location | |||||||||
| Address1: | 4930 S SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741455712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183924008 | ||||||||
| FaxNumber: | 9183924009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2012 | ||||||||
| LastUpdateDate: | 01/13/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1923 | OK | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 106H00000X | 1142 | OK | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.