Healthcare Provider Details

I. General information

NPI: 1467002923
Provider Name (Legal Business Name): GLIDDEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 WASHINGTON AVE STE 205
SANDPOINT ID
83864-5055
US

IV. Provider business mailing address

1106 POPLAR ST.
SANDPOINT ID
83864
US

V. Phone/Fax

Practice location:
  • Phone: 208-597-0994
  • Fax: 208-701-6277
Mailing address:
  • Phone: 208-597-0994
  • Fax: 208-701-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: BROM GLIDDEN
Title or Position: OWNER
Credential: LCPC
Phone: 208-597-0994