MEDICARE: GLIMMER COUNSELING GROUP, LLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1932063823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLIMMER COUNSELING GROUP, LLC

Provider Business Mailing Address
First Line	:	1900 PLEASANT ST UNIT 39
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 PLEASANT ST UNIT 39
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3624
Country	:	US
Telephone Number	:	317-537-1484
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAYLER KOSTECKA
Credential	:
Telephone Number	:	317-966-2405

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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