Provider Demographics
NPI:1083847396
Name:GLENN, FRANK OLIVER IV (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:OLIVER
Last Name:GLENN
Suffix:IV
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-1109
Mailing Address - Country:US
Mailing Address - Phone:503-791-4368
Mailing Address - Fax:360-226-1755
Practice Address - Street 1:115 OREGON AVE S
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631
Practice Address - Country:US
Practice Address - Phone:503-791-4368
Practice Address - Fax:360-226-1755
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YM0800XOtherLH