Provider Demographics
NPI:1558386755
Name:GLENN, SANDRA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:G
Last Name:GLENN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11631 CHESSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1330
Mailing Address - Country:US
Mailing Address - Phone:713-480-1122
Mailing Address - Fax:
Practice Address - Street 1:13426 INDIANAPOLIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3827
Practice Address - Country:US
Practice Address - Phone:713-480-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0103109804Medicaid
TX0103109803Medicaid
TX103109801Medicaid
TX0103109804Medicaid
TX0103109803Medicaid
TX00645PMedicare ID - Type UnspecifiedTPI