Provider Demographics
NPI:1649598459
Name:RIDDLES, MISSY (LPC)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:
Last Name:RIDDLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7569
Mailing Address - Country:US
Mailing Address - Phone:405-265-8866
Mailing Address - Fax:
Practice Address - Street 1:11219 W RENO AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7569
Practice Address - Country:US
Practice Address - Phone:405-265-8866
Practice Address - Fax:405-265-8866
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional