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General NPI Number Information
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NPI Number | 1205035458
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Entity Type | Organization
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Legal Business Name | VINCENT A GLASS PSY D INC P C
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 3201 N MUSTANG RD STE A
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City | YUKON
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State | OK
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Zip | 73099-3399
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Country | US
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Telephone | 405-354-5777
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Fax | 405-324-9512
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Provider Business Mailing Address
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Address Line | 3201 N MUSTANG RD STE A
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City | YUKON
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State | OK
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Zip | 73099-3399
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Country | US
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Telephone | 405-354-5777
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Fax | 405-324-9512
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT ARTHUR GLASS
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Credential | PSY.D.
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Telephone | 405-354-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 765
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License Number State | OK
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