Individual
CEDRIC GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1721 E 72ND ST, 1803, TULSA, OK 74136-5372
(813) 388-3773
Mailing address
1721 E 72ND ST, 1803, TULSA, OK 74136-5372
(813) 388-3773
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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