Provider Demographics
NPI:1407249337
Name:GLOCKLER, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GLOCKLER
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 1:212 S GROVE ST STE F
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4006
Mailing Address - Country:US
Mailing Address - Phone:828-222-7949
Mailing Address - Fax:844-234-7856
Practice Address - Street 1:212 S GROVE ST STE F
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4006
Practice Address - Country:US
Practice Address - Phone:828-222-7949
Practice Address - Fax:844-234-7856
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1721106H00000X
NC1941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004083606Medicaid