Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 347 | OK |
NPI | 1003006792 |
---|---|
Provider Name | Dr. Marshall Andrew Glenn |
First Address | Norman, OK 73072-1961 |
Second Address | Norman, OK 73072-1961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 28/07/2007 |