Healthcare Provider Details

I. General information

NPI: 1922545920
Provider Name (Legal Business Name): CHARLES CURTIS NESTELL JR. M.A., LADC/MH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 NW 47TH ST
LAWTON OK
73505-4757
US

IV. Provider business mailing address

823 MISSION DR
ANADARKO OK
73005-5435
US

V. Phone/Fax

Practice location:
  • Phone: 580-956-4827
  • Fax:
Mailing address:
  • Phone: 405-933-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1402
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: