Provider Demographics
NPI:1821441007
Name:GLASS, ELENA (MA, NCC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 CORPORATE DR
Mailing Address - Street 2:ST 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1985
Mailing Address - Country:US
Mailing Address - Phone:757-839-8530
Mailing Address - Fax:
Practice Address - Street 1:6760 CORPORATE DR
Practice Address - Street 2:ST 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1985
Practice Address - Country:US
Practice Address - Phone:757-839-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0105306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health