Provider Demographics
NPI:1568907228
Name:GLENN HONORE, SHYWANNA
Entity Type:Individual
Prefix:MRS
First Name:SHYWANNA
Middle Name:
Last Name:GLENN HONORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:GLENN-HONORE'
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3710 RAWLINS ST
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4217
Mailing Address - Country:US
Mailing Address - Phone:214-666-8127
Mailing Address - Fax:
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:SUITE 1370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4217
Practice Address - Country:US
Practice Address - Phone:214-666-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional