Individual
THALIA GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
9610 N METRO PKWY W, PHOENIX, AZ 85051-1402
(480) 964-2273
(602) 843-1560
Mailing address
1648 W TOPEKA DR, PHOENIX, AZ 85027-5338
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-23119
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LAC-19581
STATE OF AZ
AZ
Enumeration date
10/24/2022
Last updated
06/28/2024
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