Provider Demographics
NPI:1144774639
Name:WILLIAMS, GLENN D (DMIN, PC)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMIN, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UPS DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4046
Mailing Address - Country:US
Mailing Address - Phone:502-339-4511
Mailing Address - Fax:502-339-4513
Practice Address - Street 1:1700 UPS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4046
Practice Address - Country:US
Practice Address - Phone:502-339-4511
Practice Address - Fax:502-339-4513
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127375101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral