=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841863602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMBERLAND COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 887 CANYON BROOK ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81505-8905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-817-1925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2456 THERESEA LN
-----------------------------------------------------
City | GRAND JCT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81505-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-817-1925
-----------------------------------------------------
Fax | 970-245-3216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN R GLASSER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 612-817-1925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------