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NPI Code Detail

MEDICARE: NOLAN GLICK

MEDICARE: NOLAN GLICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1467317487
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOLAN GLICK
Provider Business Mailing Address
First Line : 277 E AMADOR AVE STE 101
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3675
Country : US
Telephone Number : 505-392-3482
Fax Number :
Provider Business Practice Location Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 575-520-6074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2025
Last Update Date : 12/22/2025

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Directions to “ NOLAN GLICK ” Practice Location

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