Resilient Tribal Roots, Pllc | |
2300 Mckown Dr Norman OK 73072-6678 | |
(405) 321-3600 | |
(405) 321-3612 |
Full Name | Resilient Tribal Roots, Pllc |
---|---|
Speciality | Psychologist |
Location | 2300 Mckown Dr, Norman, Oklahoma |
Authorized Official Name and Position | Glenna P. Stumblingbear-riddle (OWNER/PSYCHOLOGIST) |
Authorized Official Contact | 4053213600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Resilient Tribal Roots, Pllc 2300 Mckown Dr Norman OK 73072-6678 Ph: (405) 321-3600 | Resilient Tribal Roots, Pllc 2300 Mckown Dr Norman OK 73072-6678 Ph: (405) 321-3600 |
NPI Number | 1265090286 |
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Provider Enumeration Date | 06/04/2019 |
Last Update Date | 04/08/2022 |
Certification Date | 04/08/2022 |
Medicare PECOS PAC ID | 1355675307 |
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Medicare Enrollment ID | O20190626002311 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265090286 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
Provider Name | Glenna P. Stumblingbear-riddle |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1649553488 PECOS PAC ID: 0941457014 Enrollment ID: I20120823000947 |
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