Provider Demographics
NPI:1134686264
Name:MCDANIEL, GLORY (MA, LAC, LPC, MFTC)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MA, LAC, LPC, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12772 MT OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8205
Mailing Address - Country:US
Mailing Address - Phone:720-446-8701
Mailing Address - Fax:
Practice Address - Street 1:4180 CENTER PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4505
Practice Address - Country:US
Practice Address - Phone:720-446-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016966101YM0800X
COACD.0001212101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90000171725Medicaid