Provider Demographics
NPI:1295734929
Name:MEARS, GLEN ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:ALLEN
Last Name:MEARS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N KANSAS AVE
Mailing Address - Street 2:MEARSGLEN@GAIL.COM
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0117
Mailing Address - Country:US
Mailing Address - Phone:719-845-7956
Mailing Address - Fax:719-845-7956
Practice Address - Street 1:208 N KANSAS AVE
Practice Address - Street 2:MEARSGLEN@GAIL.COM
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-0117
Practice Address - Country:US
Practice Address - Phone:719-845-7956
Practice Address - Fax:719-845-7956
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099244471041C0700X
NMSWB-2022-11051041C0700X
TX534001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical