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General NPI Number Information
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NPI Number | 1043707094
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Entity Type | Individual
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Provider Name | URIAH GLYNN LCDC
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Gender | Male
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 6937 N INTERSTATE HWY 35
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City | AUSTIN
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State | TX
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Zip | 78752
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Country | US
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Telephone | 512-804-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 10707 LAKE CREEK PKWY APT 254
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City | AUSTIN
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State | TX
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Zip | 78750
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Country | US
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Telephone | 512-445-7787
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Fax | 512-440-4059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17455
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License Number State | TX
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