Provider Demographics
NPI:1255604872
Name:GLENNA STUMBLINGBEAR-RIDDLE, PH.D., PLLC
Entity type:Organization
Organization Name:GLENNA STUMBLINGBEAR-RIDDLE, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBLINGBEAR-RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-292-1000
Mailing Address - Street 1:1225 W MAIN ST
Mailing Address - Street 2:102
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6824
Mailing Address - Country:US
Mailing Address - Phone:405-292-1000
Mailing Address - Fax:
Practice Address - Street 1:1225 W MAIN ST
Practice Address - Street 2:102
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6824
Practice Address - Country:US
Practice Address - Phone:405-292-1000
Practice Address - Fax:405-801-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1138251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health