Healthcare Provider Details

I. General information

NPI: 1558743435
Provider Name (Legal Business Name): SARA D GLENNON LP, LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13302 GRANT RD STE 6
CYPRESS TX
77429-3505
US

IV. Provider business mailing address

13302 GRANT RD STE 6
CYPRESS TX
77429-3505
US

V. Phone/Fax

Practice location:
  • Phone: 832-377-0063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34622
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number34622
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34622
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number34622
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number34622
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number34311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: