{"npi":"1326027293","type":"NPI-1","status":"active","name":{"display":"Dr. Glen Chilstrom PH.D.","other":[],"first":"GLEN","last":"CHILSTROM","middle":"ALLEN","credential":"PH.D."},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":"VA","license":"0810001353"}]},"addresses":[{"purpose":"LOCATION","street_1":"109 S FAIRFAX ST","city":"ALEXANDRIA","state":"VA","postal_code":"223143301","country_code":"US","phone":"7037656085"},{"purpose":"MAILING","street_1":"1136 WESTMORELAND RD","city":"ALEXANDRIA","state":"VA","postal_code":"223081245","country_code":"US","phone":"7037656085"}],"license":{"state":"VA","number":"0810001353"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"7701691","state":"VA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20101220000364","type_code":"14-68","type_desc":"PRACTITIONER - CLINICAL PSYCHOLOGIST","state":"DC","pac_id":"9830387745"}]},"enumeration_date":"2006-01-10","last_updated":"2012-02-07","_meta":{"source":"NPPES","snapshot_date":"2012-02-07","doc_url":"https://findmynpi.com/api"}}