| Glidden Counseling, Llc | |
|
1224 Washington Ave Ste 205 Sandpoint ID 83864-5055 | |
| (208) 597-0994 | |
| (208) 701-6277 |
| Full Name | Glidden Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1224 Washington Ave Ste 205, Sandpoint, Idaho |
| Authorized Official Name and Position | Brom Glidden (OWNER) |
| Authorized Official Contact | 2085970994 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glidden Counseling, Llc 1106 Poplar St. Sandpoint ID 83864 Ph: (208) 597-0994 | Glidden Counseling, Llc 1224 Washington Ave Ste 205 Sandpoint ID 83864-5055 Ph: (208) 597-0994 |
| NPI Number | 1467002923 |
|---|---|
| Provider Enumeration Date | 09/17/2019 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Medicare PECOS PAC ID | 9032561378 |
|---|---|
| Medicare Enrollment ID | O20240123000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467002923 | NPI | - | NPPES |
| 807651800 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 175T00000X | Peer Specialist | (* (Not Available)) | Secondary |
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Brom Joshua Phillip Glidden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154694792 PECOS PAC ID: 0941652283 Enrollment ID: I20240123000475 |
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