Individual
JEFFREY E GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1115 ELKTON DR STE 102, COLORADO SPRINGS, CO 80907-3597
(719) 357-6471
(719) 434-9811
Mailing address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 491-2470
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY.0006385
CO
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
10/18/2019
Last updated
04/30/2024
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