Provider Demographics
NPI:1053413518
Name:GLANG, CHAD (PHD LLC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:GLANG
Suffix:
Gender:M
Credentials:PHD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E SAN RAFAEL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2405
Mailing Address - Country:US
Mailing Address - Phone:719-633-4845
Mailing Address - Fax:719-634-2563
Practice Address - Street 1:317 E SAN RAFAEL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2405
Practice Address - Country:US
Practice Address - Phone:719-633-4845
Practice Address - Fax:719-634-2563
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical