Provider Demographics
NPI:1417091810
Name:GLASS, BARBARA CHRISTINE (LP)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:CHRISTINE
Last Name:GLASS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 CIVIC CENTER PLZ
Mailing Address - Street 2:STE 201
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7710
Mailing Address - Country:US
Mailing Address - Phone:507-385-7725
Mailing Address - Fax:507-385-0576
Practice Address - Street 1:11 CIVIC CENTER PLZ
Practice Address - Street 2:STE 201
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7710
Practice Address - Country:US
Practice Address - Phone:507-385-7725
Practice Address - Fax:507-385-0576
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP1769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN674247500Medicaid
MN6155841OtherUNITED BEHAVIORAL HEALTH
MN297G6GLOtherBLUE CROSS
MN120176OtherUCARE
MN6155841OtherUNITED BEHAVIORAL HEALTH