Provider Demographics
NPI:1336327303
Name:GLOSTER, JANICE L
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:GLOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300891
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0891
Mailing Address - Country:US
Mailing Address - Phone:713-289-9999
Mailing Address - Fax:713-747-9249
Practice Address - Street 1:2626 S LOOP W
Practice Address - Street 2:177
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:713-289-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33820103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist