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General NPI Number Information
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NPI Number | 1972979938
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Entity Type | Individual
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Provider Name | JENNIFER LEA COX GLASS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 15TH MDG 755 SCOTT CIRCLE
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City | JBPH-HICKAM AFB
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State | HI
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Zip | 96853
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Country | US
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Telephone | 808-448-6377
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Fax |
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Provider Business Mailing Address
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Address Line | 1898 FORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-8320
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Country | US
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Telephone | 808-780-4556
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 080005232
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License Number State | VA
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