Healthcare Provider Details

I. General information

NPI: 1790176352
Provider Name (Legal Business Name): DR JOHN GLAZER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S JACKSON ST SUITE 520
DENVER CO
80209-3176
US

IV. Provider business mailing address

300 S JACKSON ST SUITE 520
DENVER CO
80209-3176
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3670
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN GLAZER
Title or Position: OWNER/ CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 720-722-1636