Provider Demographics
NPI:1003006792
Name:GLENN, MARSHALL ANDREW (LPC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:ANDREW
Last Name:GLENN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 GULLANE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1961
Mailing Address - Country:US
Mailing Address - Phone:405-249-4130
Mailing Address - Fax:
Practice Address - Street 1:3613 GULLANE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1961
Practice Address - Country:US
Practice Address - Phone:405-249-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional