Healthcare Provider Details

I. General information

NPI: 1720346257
Provider Name (Legal Business Name): LEE CARTER GLANCEY PSY.D., M.B.A., BCB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2507
  • Fax:
Mailing address:
  • Phone: 805-468-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number26912
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26912
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number26912
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number26912
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number26912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: