Provider Demographics
NPI:1427873702
Name:GLASS, DANIEL LOUIS (LCDC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LOUIS
Last Name:GLASS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 NORTHFORK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8612
Mailing Address - Country:US
Mailing Address - Phone:832-866-9513
Mailing Address - Fax:
Practice Address - Street 1:4914 NORTHFORK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8612
Practice Address - Country:US
Practice Address - Phone:832-866-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)