Provider Demographics
NPI:1720198823
Name:GLAZE, TRACY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:GLAZE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 GULF BREEZE PKWAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561
Mailing Address - Country:US
Mailing Address - Phone:850-934-4523
Mailing Address - Fax:850-934-4520
Practice Address - Street 1:1198 GULF BREEZE PKWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-934-4523
Practice Address - Fax:850-934-4520
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3507101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
27971Medicare ID - Type Unspecified