Healthcare Provider Details

I. General information

NPI: 1659184760
Provider Name (Legal Business Name): BRACEY DARCHAEL GLOTZHOBER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W 14TH ST UNIT D
TRAVERSE CITY MI
49684-4061
US

IV. Provider business mailing address

4176 CIRCLE VIEW DR
WILLIAMSBURG MI
49690-9334
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-0282
  • Fax:
Mailing address:
  • Phone: 231-675-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: