Basic Information
| Provider Information | |||||||||
| NPI: | 1548326200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALDEN | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N. 17TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703472120 | ||||||||
| FaxNumber: | 9703469800 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 1ST STREET | ||||||||
| Address2: | |||||||||
| City: | FT. LUPTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038572723 | ||||||||
| FaxNumber: | 3038572724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 04/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0466 | KY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 5167 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.