Healthcare Provider Details

I. General information

NPI: 1184742009
Provider Name (Legal Business Name): JAY HOWARD GLICKMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W COLLEGE AVE HMS SILVER CITY MENTAL HEALTH CENTER
SILVER CITY NM
88061
US

IV. Provider business mailing address

530 DE MOSS ST
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-8222
  • Fax: 575-542-8367
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0103521
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: