Healthcare Provider Details

I. General information

NPI: 1487296158
Provider Name (Legal Business Name): CHARLENA PRIDDY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S HUSBAND ST STE 101
STILLWATER OK
74074-3536
US

IV. Provider business mailing address

1020 S LOWRY ST
STILLWATER OK
74074-4727
US

V. Phone/Fax

Practice location:
  • Phone: 405-927-4728
  • Fax:
Mailing address:
  • Phone: 405-927-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13122
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number78765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: