Provider Demographics
NPI:1669262119
Name:OSTLUND, DOW GLENN II (MA, MS, LAC)
Entity type:Individual
Prefix:
First Name:DOW
Middle Name:GLENN
Last Name:OSTLUND
Suffix:II
Gender:M
Credentials:MA, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4413
Mailing Address - Country:US
Mailing Address - Phone:812-360-9092
Mailing Address - Fax:
Practice Address - Street 1:4140 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4413
Practice Address - Country:US
Practice Address - Phone:602-837-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health