Provider Demographics
NPI:1689904369
Name:PIERCE-THORSTENBERG, GLENNA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLENNA
Middle Name:G
Last Name:PIERCE-THORSTENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3434
Mailing Address - Country:US
Mailing Address - Phone:580-226-7286
Mailing Address - Fax:
Practice Address - Street 1:2208 HICKORY DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3434
Practice Address - Country:US
Practice Address - Phone:580-226-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical