CEDRIC GLENN (NPI# 1114321486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114321486 |
| Entity Type | Individual |
| Full Name | CEDRIC GLENN |
| Practice Address |
1721 E 72nd St 1803 Tulsa OK 74136-5372 |
| Practice Telephone | 8133883773 |
| Mailing Telephone | 8133883773 |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities | ||
| N | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
1721 E 72ND ST 1803 |
| City | TULSA |
| State | OK |
| Zip Code | 74136-5372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912520883 | Esmeralda Rosales | Behavior Technician | 7306 S. Yale Ave, Tulsa, OK 74136 | 2020-05-26 |
| 1851939631 | Kenneth Aaron Pohl | Behavior Technician | 7107 S. Braden Ave. Suite 195, Tulsa, OK 74136 | 2019-12-12 |
| 1578109195 | Brett Ray Weaver | Chiropractor | Kelly Bldg Ste 106, 6565 S Yale Ave, Tulsa, OK 74136 | 2019-11-19 |
| 1477194488 | Adhd and Mood Center of Oklahoma | Clinic/Center | 6565 South Yale Ave, Suite 706, Tulsa, OK 74136 | 2019-10-01 |
| 1093272510 | Whitney Christine Pilkenton | Registered Nurse | 6161 S. Yale Ave., Tulsa, OK 74136 | 2019-02-21 |
| 1538639190 | Osu Center for Health Sciences | Clinic/Center | 6465 S. Yale Ave. Suite 514, Tulsa, OK 74136 | 2018-11-27 |
| 1043786304 | Saint Francis Hospital, Inc. | Hospice Care, Community Based | 6600 South Yale Ave Suite 350, Tulsa, OK 74136 | 2018-10-15 |
| 1891282877 | Premier Rheumatology of Oklahoma | Internal Medicine | 6114 E. 61st Street, Tulsa, OK 74136 | 2018-04-16 |
| 1679092175 | Grace Eloise Evans | Counselor | 6655 S. Yale Ave, Tulsa, OK 74136 | 2017-09-15 |
| 1598283756 | David Oladipo Abioye | Counselor | 7110 S Utica Avenue, Suite 613, Tulsa, OK 74136 | 2017-09-07 |
| Find all providers in zip 74136 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790922185 | State of Oklahoma | Community Based Residential Treatment Facility, Mental Illness | 2323 South Harvard, Tulsa, OK 74114 | 2009-01-07 |
| 1417024761 | Volunteers of America Inc. | Community Based Residential Treatment Facility, Mental Illness | 2715 E 15th St, Tulsa, OK 74104-4713 | 2006-11-30 |
| 1881760213 | Volunteers of America Inc. | Community Based Residential Treatment Facility, Mental Illness | 3931 S Oswego Ave, Tulsa, OK 74135-2428 | 2006-11-28 |
| 1457356560 | Tulsa County Juvenile Justice Trust Authority | Community Based Residential Treatment Facility, Mental Illness | 4012 E 35th St, Tulsa, OK 74135-4528 | 2005-06-15 |
| 1922440171 | Tulsa Center for Behaviour Health | Community Based Residential Treatment Facility, Mental Illness | 2323 S Harvard Ave, Tulsa, OK 74114-3301 | 2013-07-29 |
| 1982943445 | Brookhaven Hospital | Community Based Residential Treatment Facility, Mental Illness | 201 S Garnett Rd, Tulsa, OK 74128-1805 | 2013-02-04 |
| 1225030695 | Volunteers of America Inc., Crewson Youth Centers | Community Based Residential Treatment Facility, Mental Illness | 4012 E 35th St, Tulsa, OK 74135-4528 | 2005-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801321070 | April Brock | Community Based Residential Treatment Facility, Mental Illness | 106 12th Ave Ne, Miami, OK 74354-3373 | 2017-04-25 |
| 1083058523 | Mongo Allen | Community Based Residential Treatment Facility, Mental Illness | 829 Nw 142nd St, Edmond, OK 73013-1962 | 2013-04-27 |
| 1801133236 | Southeastern Oklahoma Family Services | Community Based Residential Treatment Facility, Mental Illness | 1501 N Washington Ave, Durant, OK 74701-2127 | 2013-01-04 |
| 1043595879 | Oaktree Counseling Services | Community Based Residential Treatment Facility, Mental Illness | 2104 Nw Britni Cir, Lawton, OK 73505-3121 | 2011-10-12 |
| 1790089829 | Southern Oklahoma Treatment Services | Community Based Residential Treatment Facility, Mental Illness | 5862 Us Hwy 70, Mead, OK 73449 | 2011-01-04 |
| 1285966747 | Dr. C Professional Services, Pllc | Community Based Residential Treatment Facility, Mental Illness | 7109 S Kentucky Ave, Oklahoma City, OK 73159-3427 | 2010-02-09 |
| 1881921898 | Sequoyah Residential Mental Health Facility, Inc | Community Based Residential Treatment Facility, Mental Illness | 103 N Wheeler Ave, Sallisaw, OK 74955-4617 | 2009-11-11 |
| 1558570309 | Meadow Brook Residential Care Facility | Community Based Residential Treatment Facility, Mental Illness | 1000 Meadow Lane, Howe, OK 74940 | 2007-05-21 |
| 1568580108 | Transition House, Inc. | Community Based Residential Treatment Facility, Mental Illness | 700 Asp Ave, Suite 2, Norman, OK 73069-4900 | 2007-03-26 |
| 1679665079 | Williams Counseling LLC | Community Based Residential Treatment Facility, Mental Illness | 824 Annie Court, Norman, OK 73069-4236 | 2006-09-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.