Provider Demographics
NPI:1942435532
Name:ROYSTER, GLORIA JOHNSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JOHNSON
Last Name:ROYSTER
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 1:1100 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2956
Mailing Address - Country:US
Mailing Address - Phone:270-689-6500
Mailing Address - Fax:270-689-6677
Practice Address - Street 1:233 N TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1436
Practice Address - Country:US
Practice Address - Phone:270-389-3240
Practice Address - Fax:270-689-6677
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical