Provider Demographics
NPI:1619188836
Name:DR. TANIA GLENN & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DR. TANIA GLENN & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-323-6994
Mailing Address - Street 1:1106 CLAYTON LN
Mailing Address - Street 2:SUITE 445-E
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1066
Mailing Address - Country:US
Mailing Address - Phone:512-323-6994
Mailing Address - Fax:512-323-9490
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:SUITE 445-E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-323-6994
Practice Address - Fax:512-323-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty