Provider Demographics
NPI:1467769851
Name:WOOLDRIDGE, DIANA DAYL (MHR)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:DAYL
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5550 S GARNETT RD STE 200
Mailing Address - Street 2:5550 S GARNETT, SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6830
Mailing Address - Country:US
Mailing Address - Phone:918-665-2501
Mailing Address - Fax:918-665-2501
Practice Address - Street 1:5550 S GARNETT RD STE 200
Practice Address - Street 2:5550 S GARNETT, SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-6830
Practice Address - Country:US
Practice Address - Phone:918-665-2501
Practice Address - Fax:918-665-2501
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK320800000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness