Provider Demographics
NPI:1790865152
Name:GLENN, HEATHER (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3916
Mailing Address - Country:US
Mailing Address - Phone:940-382-5328
Mailing Address - Fax:940-898-8527
Practice Address - Street 1:1512 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3916
Practice Address - Country:US
Practice Address - Phone:940-382-5328
Practice Address - Fax:940-898-8527
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10008973OtherAMERIGROUP PROVIDER NUMBE
TX83007LOtherBCBS PROVIDER NUMBER