Doctor Name: | ANITA GLENN-RELLER |
NPI Number: | 1679676571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2817 |
Business Practice Address: | 317 Lightning Ave Luke Afb, AZ - 85309 |
Business Phone Number: | 6238568754 |
Business Fax Number: | |
Mailing Address: | 13327 N 152nd Ave, SURPRISE |
State: | AZ |
Postal Code: | 853799119 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2817 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |