Healthcare Provider Details

I. General information

NPI: 1174224794
Provider Name (Legal Business Name): STEPHANIE GLENNIE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE GLENNIE LPC

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

IV. Provider business mailing address

2492 HARRISON AVE
ROCHESTER HILLS MI
48307-4741
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8700
  • Fax:
Mailing address:
  • Phone: 734-323-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: