Provider Demographics
NPI:1851832612
Name:STROUSE, GLENN (BCBA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:STROUSE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20415 CANVAS BACK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9400
Mailing Address - Country:US
Mailing Address - Phone:352-460-8008
Mailing Address - Fax:
Practice Address - Street 1:20415 CANVAS BACK RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:FL
Practice Address - Zip Code:32702-9400
Practice Address - Country:US
Practice Address - Phone:352-460-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-15583103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst