Provider Demographics
NPI:1003316126
Name:GLERUP, CASSIE (QMHA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:GLERUP
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:GLERUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2615
Mailing Address - Country:US
Mailing Address - Phone:541-523-3646
Mailing Address - Fax:541-523-7602
Practice Address - Street 1:2200 4TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2615
Practice Address - Country:US
Practice Address - Phone:541-523-3646
Practice Address - Fax:541-523-7602
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor