Provider Demographics
NPI:1215587480
Name:GLOVER-SMITH, BROGAN GABRIELLA
Entity Type:Individual
Prefix:
First Name:BROGAN
Middle Name:GABRIELLA
Last Name:GLOVER-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 CORDATA PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8278
Mailing Address - Country:US
Mailing Address - Phone:360-922-6977
Mailing Address - Fax:360-922-3737
Practice Address - Street 1:4350 CORDATA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8278
Practice Address - Country:US
Practice Address - Phone:360-922-6977
Practice Address - Fax:360-922-3737
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61006597101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor