Provider Demographics
NPI:1518050541
Name:SPRINGSTED SPENCER, GLENDA (LCSW, LAT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:SPRINGSTED SPENCER
Suffix:
Gender:F
Credentials:LCSW, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2126
Mailing Address - Country:US
Mailing Address - Phone:307-764-4107
Mailing Address - Fax:
Practice Address - Street 1:1201 E 7TH ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2126
Practice Address - Country:US
Practice Address - Phone:307-764-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT-372101YA0400X
NDLCSW-49091041C0700X
WYLCSW-10861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22437OtherBCBS PROVIDER #