Healthcare Provider Details

I. General information

NPI: 1942516216
Provider Name (Legal Business Name): GLORIA JEAN CROTTY LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S GARNETT RD
TULSA OK
74128-1803
US

IV. Provider business mailing address

141 S GARNETT RD
TULSA OK
74128-1803
US

V. Phone/Fax

Practice location:
  • Phone: 918-764-9300
  • Fax: 918-764-9275
Mailing address:
  • Phone: 918-764-9300
  • Fax: 918-764-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1954
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number233
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: