Glen Benjamin Paddock, PHD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LF00001755 Issued in WA

Practice address

4007 Bridgeport Way W
Suite F2
University Place, WA 98466-4330

Phone

(253) 565-2208

NPI assigned

Jan 7, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Richard P. Brooks, Jr., Arnp, Inc.

  dba Behavioral Healthcare Inc.

  • Psychiatric/Mental Health Registered Nurse
  • Hoquiam, WA
  • NPI 1659914000
  NPD (past)

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

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262822400000",
    "number": "1447580857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16513 133RD PL SE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980586968",
            "telephone_number": "206-619-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 BRIDGEPORT WAY W",
            "address_2": "SUITE F2",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664330",
            "telephone_number": "253-565-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADDOCK",
        "first_name": "GLEN",
        "middle_name": "BENJAMIN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF00001755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debora W Overstreet, MD
• Pacheco & Henry DDS PS (Bridgeport Family Dentistry)
• Pacific Northwest Plastic Surgery, PS
• Pacific Vision & Hearing, PLLC
• Pacific Wellness and Spa Inc
• Jae B. Pak, PHARMD
• Cheery Gilnor Acerden Palomo, PT
• Erin Renee Pankey
• Yong Park, DDS
• Josette Darlene Parker, LICSW

• Marriage & Family Therapist in University Place, WA
• Providers in University Place, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; 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.