Provider Demographics
NPI:1144345786
Name:ANDRESEN, GLENDA LEE (MFT)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LEE
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 AZALEA DR
Mailing Address - Street 2:#4
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5747
Mailing Address - Country:US
Mailing Address - Phone:970-217-2026
Mailing Address - Fax:
Practice Address - Street 1:1739 AZALEA DR
Practice Address - Street 2:#4
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5747
Practice Address - Country:US
Practice Address - Phone:970-217-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO632106H00000X
CA36437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist