Provider Demographics
NPI:1629105960
Name:HILLEY, GLENDA FAE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:FAE
Last Name:HILLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3425
Mailing Address - Country:US
Mailing Address - Phone:575-323-3354
Mailing Address - Fax:575-523-3354
Practice Address - Street 1:3100 OAK ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3425
Practice Address - Country:US
Practice Address - Phone:575-323-3354
Practice Address - Fax:575-523-3354
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM16051041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28952278Medicaid