Provider Demographics
NPI:1548475411
Name:VAN BUREN, GLENDA LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:LOUISE
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NESMITH PL
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-8996
Mailing Address - Country:US
Mailing Address - Phone:979-201-6867
Mailing Address - Fax:
Practice Address - Street 1:127 NESMITH PL
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-8996
Practice Address - Country:US
Practice Address - Phone:979-201-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health