MEDICARE: DEBRA LYNN GLENN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	106705	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000071068	OTHER	MT	BLUE CROSS-SHIELD OF MONTANA

General Provider Information

NPI Number	:	1083999791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA LYNN GLENN LCSW

Provider Business Mailing Address
First Line	:	260 SUGAR CREEK LN
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-6750
Country	:	US
Telephone Number	:	307-421-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 WAIN DR
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-1231
Country	:	US
Telephone Number	:	903-321-8747
Fax Number	:	903-236-8510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	09/21/2022

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