Provider Demographics
NPI:1245633429
Name:GLOVER, TROY O'NEAL (CPRSS)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:O'NEAL
Last Name:GLOVER
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 CADDO HWY
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-4204
Mailing Address - Country:US
Mailing Address - Phone:580-924-7330
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701
Practice Address - Country:US
Practice Address - Phone:580-924-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor