Individual
GLENNA RAE MCGIRR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
15145A LAKESHORE DR, CLEARLAKE, CA 95422-8106
(707) 944-7090
(707) 994-7096
Mailing address
3795 SPRING VALLEY RD, CLEARLAKE OAKS, CA 95423-9407
(707) 994-7090
(707) 994-7096
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 22842
CA
Other
Enumeration date
02/02/2007
Last updated
07/08/2007
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