Provider Demographics
NPI:1740304088
Name:GRUNZ, GLEN ROBERT (LCPC)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:ROBERT
Last Name:GRUNZ
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:MR
Other - First Name:GLEN
Other - Middle Name:ROBERT
Other - Last Name:GRUNZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1430 LEGENDS CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5813
Mailing Address - Country:US
Mailing Address - Phone:785-832-0400
Mailing Address - Fax:785-841-1389
Practice Address - Street 1:1430 LEGENDS CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5813
Practice Address - Country:US
Practice Address - Phone:785-832-0400
Practice Address - Fax:785-841-1389
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional