Healthcare Provider Details

I. General information

NPI: 1518894179
Provider Name (Legal Business Name): JULIET GLASS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25991 FERN GULCH RD
EVERGREEN CO
80439-5617
US

IV. Provider business mailing address

25991 FERN GULCH RD
EVERGREEN CO
80439-5617
US

V. Phone/Fax

Practice location:
  • Phone: 719-726-3403
  • Fax: 720-362-2968
Mailing address:
  • Phone: 719-726-3403
  • Fax: 720-362-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIET JOY GLASS
Title or Position: OWNER/ PSYCH NP
Credential: PMHNP-BC
Phone: 719-726-3403