Provider Demographics
NPI:1013265933
Name:GLASS, MARY ELIZABETH (LMHC, CRCC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:GLASS
Suffix:
Gender:F
Credentials:LMHC, CRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6820 PORTO FINO CIRCLE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7133
Mailing Address - Country:US
Mailing Address - Phone:239-225-1364
Mailing Address - Fax:239-225-7337
Practice Address - Street 1:6820 PORTO FINO CIRCLE
Practice Address - Street 2:SUITE 1
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7133
Practice Address - Country:US
Practice Address - Phone:239-225-1364
Practice Address - Fax:239-225-7337
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
103TC1900X
FLMH2377103TR0400X
ILCRC000050902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation