Provider Demographics
NPI:1124044938
Name:GLESSNER, PHILIP EDWARD (MFT, LADC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:EDWARD
Last Name:GLESSNER
Suffix:
Gender:M
Credentials:MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3244
Mailing Address - Country:US
Mailing Address - Phone:702-493-6745
Mailing Address - Fax:725-204-9447
Practice Address - Street 1:10655 PARK RUN DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4590
Practice Address - Country:US
Practice Address - Phone:702-493-6745
Practice Address - Fax:725-204-9447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLADC #782101YA0400X
NVMFT #0694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)