Misty Anne Glenn, CDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

60701395 Issued in WA

Practice address

121 NW Chehalis Ave
Chehalis, WA 98532

Phone

(360) 740-9767

Fax

(360) 740-5484

NPI assigned

May 31, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Misty Anne Nelson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eugenia Center

  • Substance Abuse Rehabilitation Facility
  • Chehalis, WA
  • NPI 1376696096
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1396273637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NW CHEHALIS AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98531",
            "telephone_number": "360-740-9767",
            "fax_number": "360-740-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 NW CHEHALIS AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-740-9767",
            "fax_number": "360-740-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "MISTY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60701395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "NELSON",
            "middle_name": "ANNE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Martine Geiger, ARNP
• Marles Jean Geist, RN, ARNP
• Todd L Gentzler, P.T.
• Darcy Jean Gibbons
• Lyle Givens, AAS, SUDP
• Melissa Nicole Glidewell
• Erin Marie Godfrey, NP
• Gold Line Counseling, PLLC
• Amy Gomez Moreno, CNA
• Hailey Gooch, B.S., AAC

• Addiction (Substance Use Disorder) Counselor in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.