| |
352 2nd St Nw Ste 105 Hickory NC 28601-4954 | |
(828) 781-0778 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 352 2nd St Nw Ste 105, Hickory, North Carolina |
Authorized Official Name and Position | Travis Shay Glass (OWNER) |
Authorized Official Contact | 8287810778 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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528 2nd St Nw Hickory NC 28601-4908 Ph: (828) 781-0778 | 352 2nd St Nw Ste 105 Hickory NC 28601-4954 Ph: (828) 781-0778 |
NPI Number | 1124871306 |
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Provider Enumeration Date | 04/08/2024 |
Last Update Date | 05/31/2024 |
Certification Date | 05/31/2024 |
Medicare PECOS PAC ID | 4880130822 |
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Medicare Enrollment ID | O20240725003056 |
Identifier | Type | State | Issuer |
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1124871306 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Travis Shay Glass |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1932384542 PECOS PAC ID: 5799221735 Enrollment ID: I20240726001111 |
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