| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 06/04/2019 |
| Last Update Date | 04/08/2022 |
| Certification Date | 04/08/2022 |
| Medicare PECOS PAC ID | 1355675307 |
|---|---|
| Medicare Enrollment ID | O20190626002311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265090286 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | () | Primary |
| Provider Name | Glenna Pearl Stumblingbear-riddle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649553488 PECOS PAC ID: 0941457014 Enrollment ID: I20120823000947 |
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