Provider Demographics
NPI:1598207847
Name:GLENN-LEWIS, DELORES
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:GLENN-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DELORES
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 E CHARLESTON BLVD
Mailing Address - Street 2:226
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6659
Mailing Address - Country:US
Mailing Address - Phone:702-968-5071
Mailing Address - Fax:702-938-1497
Practice Address - Street 1:4000 E CHARLESTON BLVD
Practice Address - Street 2:226
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6659
Practice Address - Country:US
Practice Address - Phone:702-968-5071
Practice Address - Fax:702-938-1497
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor