Provider Demographics
NPI:1770186710
Name:M L GLADNEY
Entity Type:Organization
Organization Name:M L GLADNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-382-7698
Mailing Address - Street 1:9409 ASPEN RIDGE DR APT 233
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-7007
Mailing Address - Country:US
Mailing Address - Phone:817-724-2887
Mailing Address - Fax:
Practice Address - Street 1:262 CARROLL ST # 20
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1907
Practice Address - Country:US
Practice Address - Phone:817-382-7698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health