Provider Demographics
NPI:1659184760
Name:GLOTZHOBER, BRACEY DARCHAEL (LLPC)
Entity type:Individual
Prefix:
First Name:BRACEY
Middle Name:DARCHAEL
Last Name:GLOTZHOBER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4176 CIRCLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9334
Mailing Address - Country:US
Mailing Address - Phone:231-675-4776
Mailing Address - Fax:
Practice Address - Street 1:525 W 14TH ST UNIT D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4061
Practice Address - Country:US
Practice Address - Phone:231-714-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty