Provider Demographics
NPI:1932270022
Name:RIDDLES, GEORGE JAMES (LPC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JAMES
Last Name:RIDDLES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:RIDDLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:10325 E ROSE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-3822
Mailing Address - Country:US
Mailing Address - Phone:918-341-3885
Mailing Address - Fax:918-341-3885
Practice Address - Street 1:417 W PATTI PAGE BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7837
Practice Address - Country:US
Practice Address - Phone:918-342-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional