Provider Demographics
NPI:1275557159
Name:GLASS, BRENT (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:GLASS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 THOMASSON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3954
Mailing Address - Country:US
Mailing Address - Phone:214-334-2746
Mailing Address - Fax:214-946-4690
Practice Address - Street 1:8035 E R L THORNTON FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7018
Practice Address - Country:US
Practice Address - Phone:214-334-2746
Practice Address - Fax:214-946-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health