| Doctor Name: | DR. MARY ELIZABETH GLASS |
| NPI Number: | 1013265933 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC, CRCC |
| License Number: | |
| Business Practice Address: | 6820 Porto Fino Circle Suite 1 Ft Myers, FL - 339127133 |
| Business Phone Number: | 2392251364 |
| Business Fax Number: | 2392257337 |
| Mailing Address: | 6820 Porto Fino Circle, Suite 1 FT MYERS |
| State: | FL |
| Postal Code: | 339127133 |
| Phone Number: | 2392251364 |
| Fax Number: | 2392257337 |
| NPI Enumeration Date: | 08/27/2012 |
| NPI Last Update Date: | 08/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |