MEDICARE: COURTNEY GLICKEN

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

General Provider Information

NPI Number	:	1942870605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GLICKEN

Provider Business Mailing Address
First Line	:	7042 VILLAGE DR
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-3824
Country	:	US
Telephone Number	:	719-238-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	7471 RUDELL RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-4278
Country	:	US
Telephone Number	:	951-900-4414
Fax Number	:

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

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	06/25/2021

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Directions to “ COURTNEY GLICKEN ” Practice Location

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