Provider Demographics
NPI:1508876749
Name:MAYES, GLENN HOWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:HOWARD
Last Name:MAYES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9030
Mailing Address - Country:US
Mailing Address - Phone:580-536-7354
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 4303 PITMAN AND THOMAS
Practice Address - Street 2:
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-353-1131
Practice Address - Fax:580-353-0340
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical