Provider Demographics
NPI:1659756989
Name:GLENN, JUAN IGNACIO (MA, LMTF)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:IGNACIO
Last Name:GLENN
Suffix:
Gender:M
Credentials:MA, LMTF
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:IGNACIO
Other - Last Name:SONEYRA OSSOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11245 HURON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2806
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001853106H00000X
CAIMF86996106H00000X
CA109529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist