Provider Demographics
NPI:1558743435
Name:GLENNON, SARA D (LP, LSSP)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:D
Last Name:GLENNON
Suffix:
Gender:F
Credentials:LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 TIMBERLOCH PL
Mailing Address - Street 2:STE. 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1171
Mailing Address - Country:US
Mailing Address - Phone:281-815-0899
Mailing Address - Fax:
Practice Address - Street 1:2002 TIMBERLOCH PL
Practice Address - Street 2:STE. 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1171
Practice Address - Country:US
Practice Address - Phone:281-815-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34622103T00000X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X
TX34311103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool