Doctor Name: | BETHANY RUTH GLINES |
NPI Number: | 1083973614 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPCC |
License Number: | |
Business Practice Address: | 1833 3rd Ave Anoka, MN - 553032424 |
Business Phone Number: | 7634215535 |
Business Fax Number: | 7634330226 |
Mailing Address: | 1833 3rd Ave, ANOKA |
State: | MN |
Postal Code: | 553032424 |
Phone Number: | 7634215535 |
Fax Number: | 7634330226 |
NPI Enumeration Date: | 05/16/2012 |
NPI Last Update Date: | 01/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |