Provider Demographics
NPI:1558418756
Name:FAULKNER-WOODLIFF, GLENDA JEAN (LPC, LPC-S)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:JEAN
Last Name:FAULKNER-WOODLIFF
Suffix:
Gender:F
Credentials:LPC, LPC-S
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:JEAN
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7513 TEAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-7807
Mailing Address - Country:US
Mailing Address - Phone:817-479-3105
Mailing Address - Fax:847-565-8052
Practice Address - Street 1:101 BOURLAND RD STE C
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3507
Practice Address - Country:US
Practice Address - Phone:817-479-3105
Practice Address - Fax:847-565-8052
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional