Provider Demographics
NPI:1669429494
Name:GLEZEN, ALISON JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:JEAN
Last Name:GLEZEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3011 HOOD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4926
Mailing Address - Country:US
Mailing Address - Phone:469-235-2484
Mailing Address - Fax:214-771-0593
Practice Address - Street 1:3011 HOOD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4926
Practice Address - Country:US
Practice Address - Phone:469-235-2484
Practice Address - Fax:214-771-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-1273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0410888-07Medicaid
TX0410888-07Medicaid