Provider Demographics
NPI:1295902542
Name:GLENN, SONDRA G (BA)
Entity type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:G
Last Name:GLENN
Suffix:
Gender:F
Credentials:BA
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Mailing Address - Street 1:124 S BROADWAY AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5807
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8773
Practice Address - Street 1:124 S BROADWAY AVE STE 408
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5807
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8773
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)