Provider Demographics
NPI:1457018194
Name:NEWBERRY, GLENN (LPC-S)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 RICHTER CT
Mailing Address - Street 2:
Mailing Address - City:TOLAR
Mailing Address - State:TX
Mailing Address - Zip Code:76476-5010
Mailing Address - Country:US
Mailing Address - Phone:214-536-6172
Mailing Address - Fax:
Practice Address - Street 1:10306 RICHTER CT
Practice Address - Street 2:
Practice Address - City:TOLAR
Practice Address - State:TX
Practice Address - Zip Code:76476-5010
Practice Address - Country:US
Practice Address - Phone:214-536-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional