Provider Demographics
NPI:1629083381
Name:SAMMIS, GLENN C (LPC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:C
Last Name:SAMMIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 BROADWAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6340
Mailing Address - Country:US
Mailing Address - Phone:210-860-0888
Mailing Address - Fax:210-826-6106
Practice Address - Street 1:8546 BROADWAY
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6340
Practice Address - Country:US
Practice Address - Phone:210-860-0888
Practice Address - Fax:210-826-6106
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164667102Medicaid