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General NPI Number Information
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NPI Number | 1255604872
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Entity Type | Organization
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Legal Business Name | GLENNA STUMBLINGBEAR-RIDDLE, PH.D., PLLC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 1225 W MAIN ST 102
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City | NORMAN
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State | OK
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Zip | 73069-6824
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Country | US
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Telephone | 405-292-1000
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Fax | 405-801-2506
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Provider Business Mailing Address
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Address Line | 1225 W MAIN ST 102
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City | NORMAN
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State | OK
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Zip | 73069-6824
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Country | US
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Telephone | 405-292-1000
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. GLENNA STUMBLINGBEAR-RIDDLE
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Credential | PH.D.
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Telephone | 405-292-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1138
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License Number State | OK
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