Provider Demographics
NPI:1396846879
Name:HAMMER, GLENN L (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:L
Last Name:HAMMER
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 N 4TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2091
Mailing Address - Country:US
Mailing Address - Phone:307-721-0700
Mailing Address - Fax:307-721-1039
Practice Address - Street 1:1575 N 4TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-721-0700
Practice Address - Fax:307-721-1039
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC804101Y00000X
WYLPC-804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312848OtherBLUE CROSS BLUE SHEILD