Healthcare Provider Details

I. General information

NPI: 1871363713
Provider Name (Legal Business Name): GLIMMER SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 ANNA JEAN CT
SANTA FE NM
87505-5275
US

IV. Provider business mailing address

2313 ANNA JEAN CT
SANTA FE NM
87505-5275
US

V. Phone/Fax

Practice location:
  • Phone: 505-469-2839
  • Fax:
Mailing address:
  • Phone: 505-469-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JHERI STELZER
Title or Position: FOUNDER
Credential: BCBA
Phone: 505-469-2839