Provider Demographics
NPI:1073107488
Name:GLADE COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:GLADE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLADE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:810-626-5196
Mailing Address - Street 1:211 N 1ST ST STE 213
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1297
Mailing Address - Country:US
Mailing Address - Phone:810-626-5196
Mailing Address - Fax:
Practice Address - Street 1:540 NAPA VALLEY DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1055
Practice Address - Country:US
Practice Address - Phone:810-626-5196
Practice Address - Fax:810-626-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)