MEDICARE: GLENDA P WALDEN LPC

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	101YM0800X	Mental Health Counselor	0466	KY
2	101YM0800X	Mental Health Counselor	5167	CO

General Provider Information

NPI Number	:	1548326200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA P WALDEN LPC

Provider Business Mailing Address
First Line	:	1300 N. 17TH AVENUE
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631
Country	:	US
Telephone Number	:	970-347-2120
Fax Number	:	970-346-9800

Provider Business Practice Location Address
First Line	:	120 1ST STREET
Second Line	:
City	:	FT. LUPTON
State	:	CO
Zip	:	80621
Country	:	US
Telephone Number	:	303-857-2723
Fax Number	:	303-857-2724

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	04/14/2010

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