Provider Demographics
NPI:1821067380
Name:BRICKEN, GLENN JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOSEPH
Last Name:BRICKEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25810 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2016
Mailing Address - Country:US
Mailing Address - Phone:281-364-0067
Mailing Address - Fax:281-364-0712
Practice Address - Street 1:25810 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2016
Practice Address - Country:US
Practice Address - Phone:281-364-0067
Practice Address - Fax:281-364-0712
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16836103TC0700X
TX24595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680003046OtherRAILROAD MEDICARE PIN
TX81527POtherBCBSTX PIN
TX098942801Medicaid
TX098942801Medicaid
TX81527PMedicare ID - Type UnspecifiedINDIVIDUAL ID FOR GROUP
TX81527PMedicare PIN