Provider Demographics
NPI:1164030763
Name:GLASSCOCK, BRICE DUVALL (CAS, NCAC I)
Entity Type:Individual
Prefix:MR
First Name:BRICE
Middle Name:DUVALL
Last Name:GLASSCOCK
Suffix:
Gender:M
Credentials:CAS, NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1352
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-1352
Mailing Address - Country:US
Mailing Address - Phone:970-942-8306
Mailing Address - Fax:
Practice Address - Street 1:390 YAMPA AVE
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2600
Practice Address - Country:US
Practice Address - Phone:970-824-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA.0007946101YA0400X
CO007371146N00000X
COACC.0021111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic