Provider Demographics
NPI:1083999791
Name:GLENN, DEBRA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:GLENN
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 1:260 SUGAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6750
Mailing Address - Country:US
Mailing Address - Phone:307-421-4557
Mailing Address - Fax:
Practice Address - Street 1:108 WAIN DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1231
Practice Address - Country:US
Practice Address - Phone:903-321-8747
Practice Address - Fax:903-236-8510
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000071068OtherBLUE CROSS-SHIELD OF MONTANA
MTM011001799Medicare PIN