Provider Demographics
NPI:1396185120
Name:PRICE, GLENN E (REV MDIV)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:PRICE
Suffix:
Gender:M
Credentials:REV MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 CHERRY HILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7747
Mailing Address - Country:US
Mailing Address - Phone:575-434-0517
Mailing Address - Fax:575-434-1182
Practice Address - Street 1:2396 CHERRY HILLS LOOP
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7747
Practice Address - Country:US
Practice Address - Phone:575-434-0517
Practice Address - Fax:575-434-1182
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral