Healthcare Provider Details

I. General information

NPI: 1356470108
Provider Name (Legal Business Name): GLENDA LEE ALLEN MA MFT LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 ROCK BLVD
SPARKS NV
89431
US

IV. Provider business mailing address

835 ROCK BLVD
SPARKS NV
89431
US

V. Phone/Fax

Practice location:
  • Phone: 775-355-7722
  • Fax: 775-355-7116
Mailing address:
  • Phone: 775-355-7722
  • Fax: 775-355-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number420L
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number369
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: