Provider Demographics
NPI:1922545920
Name:NESTELL, CHARLES CURTIS JR (MA, LADC/MH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CURTIS
Last Name:NESTELL
Suffix:JR
Gender:M
Credentials:MA, LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2018
Mailing Address - Country:US
Mailing Address - Phone:405-933-3757
Mailing Address - Fax:
Practice Address - Street 1:4300 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5107
Practice Address - Country:US
Practice Address - Phone:405-425-0414
Practice Address - Fax:405-419-3055
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1402101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health