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General NPI Number Information
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NPI Number | 1285455717
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Entity Type | Individual
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Provider Name | STEPHANIE GLENN
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Gender |
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 822 G ST STE 4
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City | ARCATA
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State | CA
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Zip | 95521-6247
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Country | US
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Telephone | 707-502-2083
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 EDELINE AVE
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-4105
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 148813
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License Number State | CA
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