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General NPI Number Information
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NPI Number | 1518237304
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Entity Type | Organization
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Legal Business Name | CHAD GLANG, PHD LLC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 317 E SAN RAFAEL ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2405
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Country | US
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Telephone | 719-633-4845
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Fax | 719-634-2563
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Provider Business Mailing Address
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Address Line | 317 E SAN RAFAEL ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2405
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Country | US
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Telephone | 719-633-4845
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Fax | 719-634-2563
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD GLANG
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Credential | PHD LLC
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Telephone | 719-633-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 873
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License Number State | CO
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