Organization
FULL LIFE FAMILY RESOURCE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLYNIS DANIEL LPC (PRESIDENT)
(580) 584-2478
Entity
Organization
Contact information
Practice address
205 MAIN ST, BROKEN BOW, OK 74728-3975
(580) 584-2478
(580) 584-2478
Mailing address
205 MAIN ST, BROKEN BOW, OK 74728-3975
(580) 584-2478
(580) 584-2478
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3881
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
447-76-2689
—
OK
Enumeration date
03/17/2014
Last updated
03/17/2014
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