Provider Demographics
NPI:1316980832
Name:GLENNEY, MARY JAMES (PMHCNS-BC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JAMES
Last Name:GLENNEY
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 TASAJILLO TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1416
Mailing Address - Country:US
Mailing Address - Phone:210-885-6579
Mailing Address - Fax:
Practice Address - Street 1:1515 S CAPITAL OF TEXAS HWY STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6544
Practice Address - Country:US
Practice Address - Phone:210-885-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991542-NP363LF0000X
TXAP106331363LF0000X, 364SP0809X
COAPN.0991571-CNS364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109609101Medicaid
TX109609101Medicaid
TX85N010Medicare ID - Type UnspecifiedMEDICARE NO