Provider Demographics
NPI:1578632055
Name:LOVELADY, GLORIA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:LOVELADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JEANIE
Other - Middle Name:
Other - Last Name:LOVELADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4323 E 68TH ST
Mailing Address - Street 2:UNIT 513
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4614
Mailing Address - Country:US
Mailing Address - Phone:918-523-5012
Mailing Address - Fax:
Practice Address - Street 1:4323 E 68TH ST
Practice Address - Street 2:UNIT 513
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4614
Practice Address - Country:US
Practice Address - Phone:918-523-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical