Provider Demographics
NPI:1033289863
Name:ZAEPFEL, GLENN PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:PETER
Last Name:ZAEPFEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 EVELYN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5212
Mailing Address - Country:US
Mailing Address - Phone:803-216-0850
Mailing Address - Fax:803-216-0420
Practice Address - Street 1:409 EVELYN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5212
Practice Address - Country:US
Practice Address - Phone:803-216-0850
Practice Address - Fax:803-216-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC456101YP2500X
SC488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ329080281Medicare PIN