Provider Demographics
NPI:1205991593
Name:GLASS, MARTY (LPC)
Entity type:Individual
Prefix:MR
First Name:MARTY
Middle Name:
Last Name:GLASS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5702
Mailing Address - Country:US
Mailing Address - Phone:972-407-6822
Mailing Address - Fax:972-436-4410
Practice Address - Street 1:6750 HILLCREST PLAZA DR STE 221
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1444
Practice Address - Country:US
Practice Address - Phone:972-407-6822
Practice Address - Fax:972-458-0098
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health