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General NPI Number Information
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NPI Number | 1659184760
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Entity Type | Individual
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Provider Name | BRACEY DARCHAEL GLOTZHOBER LLPC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 525 W 14TH ST UNIT D
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4061
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Country | US
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Telephone | 231-714-0282
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Fax |
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Provider Business Mailing Address
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Address Line | 4176 CIRCLE VIEW DR
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City | WILLIAMSBURG
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State | MI
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Zip | 49690-9334
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Country | US
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Telephone | 231-675-4776
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451024054
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License Number State | MI
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