1598101230 NPI number — BARBARA C GLENN LCPC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598101230 NPI number — BARBARA C GLENN LCPC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GLENN

Provider First Name:

BARBARA

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

LCPC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1598101230

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/03/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

155 LOG CANOE CIR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

STEVENSVILLE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21666-2127

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-604-0226

Provider Business Mailing Address Fax Number:

877-643-0126

Provider First Line Business Practice Location Address:

155 LOG CANOE CIR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

STEVENSVILLE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21666-2127

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-604-0226

Provider Business Practice Location Address Fax Number:

877-643-0126

Provider Enumeration Date:

05/21/2013

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101YM0800X , with the licence number:  LGP5046 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YP2500X , with the licence number: LC6123 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 520202701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 520202703 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: R968 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 609550005 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 517251 . This is a "OPTUM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7840093 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 259147-000 . This is a "MAGELLAN BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 346646 . This is a "MHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 522156095 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".