Provider Demographics
NPI:1548935067
Name:SOMMERSVILLE, NICOLE MONEE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MONEE
Last Name:SOMMERSVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MONEE
Other - Last Name:GITTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7521 S OLYMPIA AVE # 1032
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1855
Mailing Address - Country:US
Mailing Address - Phone:918-816-8863
Mailing Address - Fax:
Practice Address - Street 1:7521 S OLYMPIA AVE
Practice Address - Street 2:# 1032
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1855
Practice Address - Country:US
Practice Address - Phone:918-816-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002101106H00000X
FLMT3906106H00000X
OK10129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist