Healthcare Provider Details

I. General information

NPI: 1255653069
Provider Name (Legal Business Name): CYNTHIA ELLEN GLIDDEN-TRACEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CINDI GLIDDEN

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 02/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 N ALMA SCHOOL RD SUITE #205
CHANDLER AZ
85224-5936
US

IV. Provider business mailing address

1351 N ALMA SCHOOL RD SUITE #205
CHANDLER AZ
85224-5936
US

V. Phone/Fax

Practice location:
  • Phone: 480-491-7048
  • Fax: 480-963-2036
Mailing address:
  • Phone: 480-491-7048
  • Fax: 480-963-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3406
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: