Provider Demographics
NPI:1801385307
Name:ANI, GLORY
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:ANI
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 1:6778 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-1717
Mailing Address - Country:US
Mailing Address - Phone:775-301-2906
Mailing Address - Fax:
Practice Address - Street 1:6778 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-1717
Practice Address - Country:US
Practice Address - Phone:775-301-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst