Provider Demographics
NPI:1831634534
Name:MASSEY, GLENNA (LPC)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GRAND AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-756-1440
Practice Address - Street 1:181 GRAND AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7631
Practice Address - Country:US
Practice Address - Phone:817-756-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional