Provider Demographics
NPI:1912941535
Name:GLASS, VINCENT ARTHUR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ARTHUR
Last Name:GLASS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:373 S YUKON PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4597
Mailing Address - Country:US
Mailing Address - Phone:405-354-5777
Mailing Address - Fax:405-256-6583
Practice Address - Street 1:373 S YUKON PKWY STE D
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4597
Practice Address - Country:US
Practice Address - Phone:405-354-7777
Practice Address - Fax:405-256-6583
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical