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General NPI Number Information
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NPI Number | 1184219958
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Entity Type | Individual
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Provider Name | GLENN MATTHEW CLARE NCACI, SAP, CDCS
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Gender | Male
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 30881 EKLUTNA LAKE RD
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City | CHUGIAK
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State | AK
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Zip | 99567-5166
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Country | US
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Telephone | 907-223-4366
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 SAN JERONIMO DR
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City | ANCHORAGE
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State | AK
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Zip | 99508-2870
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Country | US
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Telephone | 907-793-3102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4153
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License Number State | AK
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