Provider Demographics
NPI:1548507635
Name:BECKNELL, GLENNA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:LEE
Last Name:BECKNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 COLFAX PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1643
Mailing Address - Country:US
Mailing Address - Phone:405-942-2720
Mailing Address - Fax:
Practice Address - Street 1:500 N MERIDIAN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5700
Practice Address - Country:US
Practice Address - Phone:405-601-7367
Practice Address - Fax:405-604-8010
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical