MEDICARE: GLORIA JEAN AL ESMAEL LPC

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	101Y00000X	Counselor	4457	OK

General Provider Information

NPI Number	:	1760602973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA JEAN AL ESMAEL LPC

Provider Business Mailing Address
First Line	:	500 N FINANCIAL TER STE G
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-4432
Country	:	US
Telephone Number	:	405-256-5996
Fax Number	:	405-265-2553

Provider Business Practice Location Address
First Line	:	500 N FINANCIAL TER STE G
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-4432
Country	:	US
Telephone Number	:	405-256-5996
Fax Number	:	405-265-2553

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	01/04/2020

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