Provider Demographics
NPI:1508315011
Name:BIRKELAND, GLORYMAR (MS)
Entity Type:Individual
Prefix:
First Name:GLORYMAR
Middle Name:
Last Name:BIRKELAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 SEDGEWICK CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8472
Mailing Address - Country:US
Mailing Address - Phone:561-777-6504
Mailing Address - Fax:
Practice Address - Street 1:1499 FOREST HILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6050
Practice Address - Country:US
Practice Address - Phone:561-777-6504
Practice Address - Fax:561-777-6504
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health