Provider Demographics
NPI:1184219958
Name:CLARE, GLENN MATTHEW (NCACI, SAP, CDCS)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MATTHEW
Last Name:CLARE
Suffix:
Gender:M
Credentials:NCACI, SAP, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 OMALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6570
Mailing Address - Country:US
Mailing Address - Phone:907-223-4266
Mailing Address - Fax:
Practice Address - Street 1:4600 OMALLEY RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6570
Practice Address - Country:US
Practice Address - Phone:907-223-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4153101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)