Provider Demographics
NPI:1891942561
Name:GLASGOW, DAVID R (LSPE, LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:LSPE, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3204
Mailing Address - Country:US
Mailing Address - Phone:931-490-6510
Mailing Address - Fax:
Practice Address - Street 1:902 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3204
Practice Address - Country:US
Practice Address - Phone:931-490-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 155101YP2500X
TNPE 614103TS0200X
TNED 500274103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPE 614OtherLIC. SENIOR PSYCHOLOGICAL EXAMINER
TNED 500274OtherSCHOOL PSYCHOLOGIST - TN DEPT OF EDUCATION
TNLPC 155OtherLIC. PROFESSIONAL COUNSELOR - MENTAL HEALTH SERVICES PROVIDER (MHSP)