Healthcare Provider Details

I. General information

NPI: 1265357396
Provider Name (Legal Business Name): CHARLES D GLASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S BELLAIRE ST STE 160
DENVER CO
80222-4314
US

IV. Provider business mailing address

PO BOX 103159
DENVER CO
80250-3159
US

V. Phone/Fax

Practice location:
  • Phone: 303-893-0112
  • Fax: 303-496-1111
Mailing address:
  • Phone: 303-893-0112
  • Fax: 303-496-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES D GLASS
Title or Position: OWNER
Credential: PHD
Phone: 303-893-0112