Provider Demographics
NPI:1023092798
Name:GLOTZBACH, LOUISE M (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:M
Last Name:GLOTZBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12842 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1601
Mailing Address - Country:US
Mailing Address - Phone:913-338-5034
Mailing Address - Fax:913-338-2092
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4035
Practice Address - Country:US
Practice Address - Phone:816-942-1811
Practice Address - Fax:816-942-0419
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY 01212103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0003575Medicare ID - Type Unspecified