1477006815 NPI number — CATHRYN ANA GLENDAY MPH, MA, LPCC

Table of content: CATHRYN ANA GLENDAY MPH, MA, LPCC (NPI 1477006815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477006815 NPI number — CATHRYN ANA GLENDAY MPH, MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLENDAY
Provider First Name:
CATHRYN
Provider Middle Name:
ANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPH, MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLENDAY
Provider Other First Name:
MARIANNA
Provider Other Middle Name:
CATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPH, MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477006815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8946
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87198-8946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-264-4082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 SAN PEDRO DR NE BLDG C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-369-6756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  CCMH0203791 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 96733365 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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