Provider Demographics
NPI:1790176352
Name:DR JOHN GLAZER, LLC
Entity Type:Organization
Organization Name:DR JOHN GLAZER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-722-1636
Mailing Address - Street 1:300 S JACKSON ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S JACKSON ST
Practice Address - Street 2:SUITE 520
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3176
Practice Address - Country:US
Practice Address - Phone:720-722-1636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3670261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health