Healthcare Provider Details

I. General information

NPI: 1255604872
Provider Name (Legal Business Name): GLENNA STUMBLINGBEAR-RIDDLE, PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W MAIN ST 102
NORMAN OK
73069-6824
US

IV. Provider business mailing address

1225 W MAIN ST 102
NORMAN OK
73069-6824
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-1000
  • Fax: 405-801-2506
Mailing address:
  • Phone: 405-292-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1138
License Number StateOK

VIII. Authorized Official

Name: DR. GLENNA STUMBLINGBEAR-RIDDLE
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 405-292-1000