Provider Demographics
NPI:1326548256
Name:GLASS, MARSHALL AARON (LMHCA, SUDP)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:AARON
Last Name:GLASS
Suffix:
Gender:M
Credentials:LMHCA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 S I ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3816
Mailing Address - Country:US
Mailing Address - Phone:650-759-1348
Mailing Address - Fax:
Practice Address - Street 1:510 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5416
Practice Address - Country:US
Practice Address - Phone:253-502-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60560416101YA0400X
WAMC61093279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)