Provider Demographics
NPI:1194863662
Name:GLASS, ALLEN RAY SR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:RAY
Last Name:GLASS
Suffix:SR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20022 BOLTON BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1948
Mailing Address - Country:US
Mailing Address - Phone:281-446-4988
Mailing Address - Fax:281-446-4988
Practice Address - Street 1:20022 BOLTON BRIDGE LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1948
Practice Address - Country:US
Practice Address - Phone:281-446-4988
Practice Address - Fax:281-446-4988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1726986Medicaid