MEDICARE: MS. RACHELLE ULANA GLAZE B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1588865786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHELLE ULANA GLAZE B.A.

Provider Business Mailing Address
First Line	:	1203 WILLOWBROOK DR SE APT 4
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-3814
Country	:	US
Telephone Number	:	256-881-4457
Fax Number	:

Provider Business Practice Location Address
First Line	:	9238 MADISON BLVD BLDG 1 SUITE 1300
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-9100
Country	:	US
Telephone Number	:	256-774-8340
Fax Number	:	256-774-8380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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