Provider Demographics
NPI:1215825567
Name:GLENN, KYLEE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:GLENN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 CANADIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2223
Mailing Address - Country:US
Mailing Address - Phone:636-248-3211
Mailing Address - Fax:636-248-3211
Practice Address - Street 1:245 S PRESTON RD STE 110
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3420
Practice Address - Country:US
Practice Address - Phone:877-772-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst