Provider Demographics
NPI:1588934087
Name:GLENN, SUE JAN (LPC-S)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:JAN
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 OLTON RD STE 103
Mailing Address - Street 2:WINCHESTER PLAZA, BX 5086
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6763
Mailing Address - Country:US
Mailing Address - Phone:806-570-6792
Mailing Address - Fax:
Practice Address - Street 1:3109 OLTON RD STE 103
Practice Address - Street 2:WINCHESTER PLAZA, BX 5086
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-6763
Practice Address - Country:US
Practice Address - Phone:806-570-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional