Provider Demographics
NPI:1518379163
Name:GLENN, BETHANY ANNE (BA)
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:ANNE
Last Name:GLENN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2095
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965-9628
Mailing Address - Country:US
Mailing Address - Phone:918-822-7391
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2095
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965-9628
Practice Address - Country:US
Practice Address - Phone:918-822-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker