Provider Demographics
NPI:1821592098
Name:CHARLES D. GLASS, PH.D., LLC
Entity Type:Organization
Organization Name:CHARLES D. GLASS, PH.D., LLC
Other - Org Name:COLORADO CENTER FOR ANXIETY & STRESS-RELATED DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER / PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-893-0112
Mailing Address - Street 1:PO BOX 103159
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80250-3159
Mailing Address - Country:US
Mailing Address - Phone:303-893-0112
Mailing Address - Fax:303-496-1111
Practice Address - Street 1:1777 S BELLAIRE ST STE 160
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4314
Practice Address - Country:US
Practice Address - Phone:303-893-0112
Practice Address - Fax:303-496-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103TC0700X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty