Provider Demographics
NPI:1760189096
Name:GLEN, DANIELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GLEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4663
Mailing Address - Country:US
Mailing Address - Phone:320-291-6130
Mailing Address - Fax:
Practice Address - Street 1:303 4TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2173
Practice Address - Country:US
Practice Address - Phone:320-406-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist