Provider Demographics
NPI:1538653746
Name:SANTIAGO, GLEN JOARLINE (CPST)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:JOARLINE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CPST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WILLIAMS BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-8211
Mailing Address - Country:US
Mailing Address - Phone:504-575-4662
Mailing Address - Fax:
Practice Address - Street 1:1800 WILLIAMS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-8211
Practice Address - Country:US
Practice Address - Phone:504-575-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool