Provider Demographics
NPI:1942516216
Name:CROTTY, GLORIA JEAN (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:CROTTY
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1803
Mailing Address - Country:US
Mailing Address - Phone:918-764-9300
Mailing Address - Fax:918-764-9275
Practice Address - Street 1:141 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1803
Practice Address - Country:US
Practice Address - Phone:918-764-9300
Practice Address - Fax:918-764-9275
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1954101YP2500X
OK233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)