Provider Demographics
NPI:1306568308
Name:GLENBROOK MENTAL HEALTH AGENCY
Entity type:Organization
Organization Name:GLENBROOK MENTAL HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:602-622-1078
Mailing Address - Street 1:6327 GLENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1019
Mailing Address - Country:US
Mailing Address - Phone:602-622-1078
Mailing Address - Fax:
Practice Address - Street 1:6440 AVONDALE DR STE 20018
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6421
Practice Address - Country:US
Practice Address - Phone:602-622-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty