Healthcare Provider Details

I. General information

NPI: 1265425565
Provider Name (Legal Business Name): CHARLES D. GLASS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
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: 970-485-9931
  • Fax: 303-496-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3088
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3088
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: