Healthcare Provider Details

I. General information

NPI: 1578786745
Provider Name (Legal Business Name): GLENN A. ALLY, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR SUITE 200
LAFAYETTE LA
70503-2852
US

IV. Provider business mailing address

155 HOSPITAL DR SUITE 200
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-8304
  • Fax: 337-235-5924
Mailing address:
  • Phone: 337-235-8304
  • Fax: 337-235-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number378MP
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number378MP
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number378MP
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number378MP
License Number StateLA

VIII. Authorized Official

Name: DR. GLENN A ALLY
Title or Position: PRESIDENT
Credential: PH.D., M.P.
Phone: 337-235-8304