Provider Demographics
NPI:1811232291
Name:GLASS HOUSE
Entity Type:Organization
Organization Name:GLASS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-586-8693
Mailing Address - Street 1:10629 TUCKERMANS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3296
Mailing Address - Country:US
Mailing Address - Phone:702-271-0504
Mailing Address - Fax:
Practice Address - Street 1:5715 W ALEXANDER RD
Practice Address - Street 2:STE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2800
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLASS HOUSE COUNSELING AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty