Provider Demographics
NPI:1790724136
Name:GLUECK, BETHANY P (PHD, LCMHC-S)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:P
Last Name:GLUECK
Suffix:
Gender:F
Credentials:PHD, LCMHC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7324
Mailing Address - Country:US
Mailing Address - Phone:919-858-2198
Mailing Address - Fax:
Practice Address - Street 1:5935 HOURGLASS CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3083
Practice Address - Country:US
Practice Address - Phone:919-696-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC3881S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790724136Medicaid