Individual
MRS. TARA MOORE GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3015 E SKELLY DR, TULSA, OK 74105-6317
(918) 712-0859
Mailing address
3015 E SKELLY DR, TULSA, OK 74105-6317
(918) 712-0859
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
OK
Enumeration date
06/14/2007
Last updated
04/01/2013
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