Provider Demographics
NPI:1578578019
Name:WOHL, GLENN (LISW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:
Last Name:WOHL
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 69 BOX 47
Mailing Address - Street 2:
Mailing Address - City:SAPELLO
Mailing Address - State:NM
Mailing Address - Zip Code:87745-9604
Mailing Address - Country:US
Mailing Address - Phone:505-454-8381
Mailing Address - Fax:
Practice Address - Street 1:HC 69 BOX 47
Practice Address - Street 2:
Practice Address - City:SAPELLO
Practice Address - State:NM
Practice Address - Zip Code:87745-9604
Practice Address - Country:US
Practice Address - Phone:505-454-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-13061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical