Provider Demographics
NPI:1003067083
Name:O'ROURKE, GLENDA RUSSELL (LPC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:RUSSELL
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GLENDA
Other - Middle Name:SUE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4716 ASHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-443-9446
Mailing Address - Fax:303-447-2173
Practice Address - Street 1:4716 ASHFIELD CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-443-9446
Practice Address - Fax:303-447-2173
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-1240101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor