Provider Demographics
NPI:1184815680
Name:LACHER, GLEN ALAN (LDC CACTT)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ALAN
Last Name:LACHER
Suffix:
Gender:M
Credentials:LDC CACTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5601
Mailing Address - Country:US
Mailing Address - Phone:303-238-1231
Mailing Address - Fax:303-238-0500
Practice Address - Street 1:10001 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5601
Practice Address - Country:US
Practice Address - Phone:303-238-1231
Practice Address - Fax:303-238-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC3114323P00000X
COCACIII 6152324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility