Provider Demographics
NPI:1588182885
Name:HARNDEN, GLEN M (PHD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:M
Last Name:HARNDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16970 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9376
Mailing Address - Country:US
Mailing Address - Phone:913-608-2441
Mailing Address - Fax:
Practice Address - Street 1:16970 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66085-9376
Practice Address - Country:US
Practice Address - Phone:913-608-2441
Practice Address - Fax:913-608-2441
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty