Provider Demographics
NPI:1811762362
Name:MAXWELL, GLENNISHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:GLENNISHA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:GLENNISHA
Other - Middle Name:
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:201 MCKINNEY VILLAGE PKWY APT 2271
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-2556
Mailing Address - Country:US
Mailing Address - Phone:214-642-0559
Mailing Address - Fax:
Practice Address - Street 1:201 MCKINNEY VILLAGE PKWY APT 2271
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-2556
Practice Address - Country:US
Practice Address - Phone:214-642-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health