=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922545920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES CURTIS NESTELL JR. M.A., LADC/MH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2017
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6100 S WALKER AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73139-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-634-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 823 MISSION DR
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005-5435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-933-3757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1402
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1402
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------