Provider Demographics
NPI:1164905253
Name:DEVENEY, GLENN WALTER (CADC I)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:WALTER
Last Name:DEVENEY
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SW EMKAY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1043
Mailing Address - Country:US
Mailing Address - Phone:541-383-0844
Mailing Address - Fax:541-383-0840
Practice Address - Street 1:920 SW EMKAY DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1043
Practice Address - Country:US
Practice Address - Phone:541-383-0844
Practice Address - Fax:541-383-0840
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-03-13101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)