Provider Demographics
NPI:1982570883
Name:GLIMMER MENTAL WELLNESS PLLC
Entity type:Organization
Organization Name:GLIMMER MENTAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:517-258-2522
Mailing Address - Street 1:2025 ABBOT RD STE 100F
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8573
Mailing Address - Country:US
Mailing Address - Phone:517-258-2522
Mailing Address - Fax:
Practice Address - Street 1:2025 ABBOT RD STE 100F
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8573
Practice Address - Country:US
Practice Address - Phone:517-258-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)