Provider Demographics
NPI:1316033202
Name:BELL, CHARLES ALLEN (MED LBP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:BELL
Suffix:
Gender:M
Credentials:MED LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21876 HOMESTEADERS PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3248
Mailing Address - Country:US
Mailing Address - Phone:405-488-9673
Mailing Address - Fax:405-285-8463
Practice Address - Street 1:21876 HOMESTEADERS PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3248
Practice Address - Country:US
Practice Address - Phone:405-488-9673
Practice Address - Fax:405-285-8463
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200291330AMedicaid