Provider Demographics
NPI:1851805436
Name:BLUMENSON, GLENN (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:BLUMENSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 3RD ST W APT 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGGINS AVE
Practice Address - Street 2:STE 409
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4433
Practice Address - Country:US
Practice Address - Phone:406-728-2539
Practice Address - Fax:406-329-5663
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-234201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical