Provider Demographics
NPI:1477170322
Name:GLOSTARS LLC
Entity Type:Organization
Organization Name:GLOSTARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LPC
Authorized Official - Phone:405-888-4047
Mailing Address - Street 1:19704 VIVACE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-5232
Mailing Address - Country:US
Mailing Address - Phone:405-888-4047
Mailing Address - Fax:405-400-2883
Practice Address - Street 1:19704 VIVACE DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-5232
Practice Address - Country:US
Practice Address - Phone:405-888-4047
Practice Address - Fax:405-400-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1477997195Medicaid