MEDICARE: DR. GLEN GERSTNER PSYD, LPC, NCC

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
1	101YM0800X	Mental Health Counselor	4302	SC
2	101YP2500X	Professional Counselor	4302	SC

General Provider Information

NPI Number	:	1609822675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN GERSTNER PSYD, LPC, NCC

Provider Business Mailing Address
First Line	:	3401 HEATHERWOOD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1952
Country	:	US
Telephone Number	:	803-256-6933
Fax Number	:	803-256-6315

Provider Business Practice Location Address
First Line	:	3103 DEVINE ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1881
Country	:	US
Telephone Number	:	803-256-6933
Fax Number	:	803-256-6315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/11/2025

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