Individual
DR. GLENN A ALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D, M.P.
Contact information
Practice address
155 HOSPITAL DR, SUITE 200, LAFAYETTE, LA 70503-2852
(337) 235-8304
(337) 235-5924
Mailing address
155 HOSPITAL DR, SUITE 200, LAFAYETTE, LA 70503-2852
(337) 235-8304
(337) 235-5924
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
378MP
LA
103TC0700X
Clinical Psychologist
378MP
LA
103TP0016X
Prescribing (Medical) Psychologist
378MP
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1969559
—
LA
Enumeration date
04/09/2007
Last updated
08/30/2007
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