Provider Demographics
NPI:1710585831
Name:GLASSCOCK, BENA LEANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BENA
Middle Name:LEANNE
Last Name:GLASSCOCK
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79001-0167
Mailing Address - Country:US
Mailing Address - Phone:806-363-0686
Mailing Address - Fax:
Practice Address - Street 1:2501 CR C
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:TX
Practice Address - Zip Code:79001
Practice Address - Country:US
Practice Address - Phone:806-363-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional