Provider Demographics
NPI:1689971301
Name:GLENN, JESSICA (LCSW-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SPRING VALLEY RD
Mailing Address - Street 2:WWW.JF-LCSW.COM
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:469-759-3966
Mailing Address - Fax:
Practice Address - Street 1:4100 SPRING VALLEY RD
Practice Address - Street 2:WWW.JF-LCSW.COM
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:469-759-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792241041C0700X
TX614221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical