Provider Demographics
NPI:1255988895
Name:DENIS, GLENNA MARY
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:MARY
Last Name:DENIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 SLEEPY HILL OAKS ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3561
Mailing Address - Country:US
Mailing Address - Phone:863-397-3229
Mailing Address - Fax:
Practice Address - Street 1:3421 SLEEPY HILL OAKS ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3561
Practice Address - Country:US
Practice Address - Phone:863-397-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health