Provider Demographics
NPI:1538274253
Name:GLASS, JODI E (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:GLASS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4056
Mailing Address - Country:US
Mailing Address - Phone:214-280-7994
Mailing Address - Fax:972-416-6726
Practice Address - Street 1:1612 MALIBU DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4056
Practice Address - Country:US
Practice Address - Phone:214-280-7994
Practice Address - Fax:972-416-6726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health