Provider Demographics
NPI:1477860039
Name:GLENN, DAWN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2526
Mailing Address - Country:US
Mailing Address - Phone:970-296-4757
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:169 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2526
Practice Address - Country:US
Practice Address - Phone:702-964-7579
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional