Provider Demographics
NPI:1114175148
Name:GLASGOW, KYLE ALAN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ALAN
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26105 ORCHARD LAKE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4576
Mailing Address - Country:US
Mailing Address - Phone:313-296-1779
Mailing Address - Fax:248-957-8544
Practice Address - Street 1:26105 ORCHARD LAKE RD
Practice Address - Street 2:STE 204
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4576
Practice Address - Country:US
Practice Address - Phone:313-296-1779
Practice Address - Fax:248-957-8544
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012482103T00000X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical