Active NPI
Shirley Glenn, ASSOCIATES
- Addiction (Substance Use Disorder) Counselor
- Highland Park, MI
National Provider Identifier
1003107301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 12501 Hamilton
Highland Park, MI 48203 - Phone
- (313) 587-3092
- NPI assigned
- Apr 21, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
12501 Hamilton
Highland Park, MI 48203
Mailing address
PO Box 725098
Berkley, MI 48072-5098
Phone (313) 587-3092
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2604097 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1003107301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 725098",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480725098",
"telephone_number": "313-587-3092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12501 HAMILTON",
"city": "HIGHLAND PARK",
"state": "MI",
"postal_code": "48203",
"telephone_number": "313-587-3092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "SHIRLEY",
"credential": "ASSOCIATES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-21",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2604097",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Highland Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.