Provider Demographics
NPI:1568843514
Name:GLORY IN SERVICE, LLC
Entity Type:Organization
Organization Name:GLORY IN SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEALA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:310-619-8514
Mailing Address - Street 1:1330 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6835
Mailing Address - Country:US
Mailing Address - Phone:405-510-4615
Mailing Address - Fax:405-225-7326
Practice Address - Street 1:1330 N CLASSEN BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6835
Practice Address - Country:US
Practice Address - Phone:405-510-4615
Practice Address - Fax:405-225-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health