Provider Demographics
NPI:1770866170
Name:HIRES, GLENNA RAE
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:RAE
Last Name:HIRES
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 1:1450 N 16TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1381
Mailing Address - Country:US
Mailing Address - Phone:509-574-5000
Mailing Address - Fax:509-249-0035
Practice Address - Street 1:1450 N 16TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1381
Practice Address - Country:US
Practice Address - Phone:509-574-5000
Practice Address - Fax:509-249-0035
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60239405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health