MEDICARE: MS. MARY JAMES GLENNEY PMHCNS-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0991542-NP	CO
2	363LF0000X	Family Nurse Practitioner	AP106331	TX
3	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	APN.0991571-CNS	CO
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	AP106331	TX

General Provider Information

NPI Number	:	1316980832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JAMES GLENNEY PMHCNS-BC

Provider Business Mailing Address
First Line	:	6339 TASAJILLO TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78739-1416
Country	:	US
Telephone Number	:	210-885-6579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 S CAPITAL OF TEXAS HWY STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-6544
Country	:	US
Telephone Number	:	210-885-6579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/11/2023

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