Individual
MR. GLEN MICHAEL BAISLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4830 S 67TH EAST AVE, TULSA, OK 74145-5838
(918) 734-1399
Mailing address
4830 S 67TH EAST AVE, TULSA, OK 74145-5838
(918) 734-1399
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4835
OK
Other
Enumeration date
02/04/2016
Last updated
02/04/2016
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