Provider Demographics
NPI:1205035458
Name:VINCENT A GLASS PSY D INC P C
Entity Type:Organization
Organization Name:VINCENT A GLASS PSY D INC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:405-354-5777
Mailing Address - Street 1:3201 N MUSTANG RD STE A
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3399
Mailing Address - Country:US
Mailing Address - Phone:405-354-5777
Mailing Address - Fax:405-324-9512
Practice Address - Street 1:3201 N MUSTANG RD STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3399
Practice Address - Country:US
Practice Address - Phone:405-354-5777
Practice Address - Fax:405-324-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty