Provider Demographics
NPI:1972511202
Name:GLADDEN, RAE MOSLEY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RAE
Middle Name:MOSLEY
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WESLEY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-9015
Mailing Address - Country:US
Mailing Address - Phone:903-269-1301
Mailing Address - Fax:903-269-1281
Practice Address - Street 1:4000 WESLEY ST
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-9015
Practice Address - Country:US
Practice Address - Phone:903-269-1301
Practice Address - Fax:903-269-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health