Provider Demographics
NPI:1649421942
Name:CLOUSE, GLENNA G (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:G
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19217 36TH AVE W
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5751
Mailing Address - Country:US
Mailing Address - Phone:206-617-2131
Mailing Address - Fax:425-412-3960
Practice Address - Street 1:19217 36TH AVE W
Practice Address - Street 2:SUITE 215
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5751
Practice Address - Country:US
Practice Address - Phone:206-617-2131
Practice Address - Fax:425-412-3960
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60188379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health