Provider Demographics
NPI:1437297124
Name:MCGIRR, GLENNA RAE (LPT)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:RAE
Last Name:MCGIRR
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:GLENNA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3795 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95423-9407
Mailing Address - Country:US
Mailing Address - Phone:707-994-7090
Mailing Address - Fax:707-994-7096
Practice Address - Street 1:15145A LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8106
Practice Address - Country:US
Practice Address - Phone:707-944-7090
Practice Address - Fax:707-994-7096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22842167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician