Provider Demographics
NPI:1235585894
Name:COTTIER, GLENDA (LMSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:COTTIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 N BROOKLINE AVE
Mailing Address - Street 2:#112
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4289
Mailing Address - Country:US
Mailing Address - Phone:405-810-0054
Mailing Address - Fax:405-810-8977
Practice Address - Street 1:6051 N BROOKLINE AVE
Practice Address - Street 2:#112
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4289
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5349104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicaid