| Organization Name: | GLADE RUN LUTHERAN SERVICES |
| NPI Number: | 1649387192 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES T LOCKWOOD (EXECUTIVE DIRECTOR) |
| Mailing Address: | Beaver Road Zelienople |
| State: | PA US |
| Postal Code: | 160630070 |
| Phone Number: | 7344524453 |
| Fax Number: | 7244526576 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 403080 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |