Provider Demographics
NPI:1700305315
Name:GLENN, HEATHER DENISE (LPC INTERN, NCC, CRC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DENISE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC INTERN, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 SW 105TH AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-435-7663
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 105TH AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-435-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor