Provider Demographics
NPI:1942439849
Name:STEELE, GLENN JR
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:STEELE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 MISSION GORGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3411
Mailing Address - Country:US
Mailing Address - Phone:619-281-3714
Mailing Address - Fax:
Practice Address - Street 1:6160 MISSION GORGE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3411
Practice Address - Country:US
Practice Address - Phone:619-281-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health