MEDICARE: DR. GLADE TOPHAM PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	872	OK

General Provider Information

NPI Number	:	1346546660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADE TOPHAM PH.D.

Provider Business Mailing Address
First Line	:	233 HUMAN ENVIRONMENTAL SCIENCES
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-6122
Country	:	US
Telephone Number	:	405-612-8370
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 HUMAN ENVIRONMENTAL SCIENCES
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-6122
Country	:	US
Telephone Number	:	405-744-8356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	02/03/2011

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