Healthcare Provider Details

I. General information

NPI: 1548305048
Provider Name (Legal Business Name): GLORIA JEAN HIMES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA JEAN FARLEY LPC

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TORREY RD STE 100
FENTON MI
48430-3327
US

IV. Provider business mailing address

540 E SOUTH HOLLY RD
FENTON MI
48430-2982
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax: 810-215-1334
Mailing address:
  • Phone: 810-624-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: