Provider Demographics
NPI:1154931509
Name:GLENN, ETHEL M (, MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:M
Last Name:GLENN
Suffix:
Gender:F
Credentials:, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CLAIRE PL
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-1704
Mailing Address - Country:US
Mailing Address - Phone:423-353-0322
Mailing Address - Fax:
Practice Address - Street 1:162 CLAIRE PL
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-1704
Practice Address - Country:US
Practice Address - Phone:423-353-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TN2180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)