Provider Demographics
NPI:1518237304
Name:CHAD GLANG, PHD LLC
Entity Type:Organization
Organization Name:CHAD GLANG, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GLANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LLC
Authorized Official - Phone:719-633-4845
Mailing Address - Street 1:317 E SAN RAFAEL ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2405
Mailing Address - Country:US
Mailing Address - Phone:719-633-4845
Mailing Address - Fax:719-634-2563
Practice Address - Street 1:317 E SAN RAFAEL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2405
Practice Address - Country:US
Practice Address - Phone:719-633-4845
Practice Address - Fax:719-634-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty