Provider Demographics
NPI:1013364504
Name:GLOSSER, JEREMY DAVID
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:GLOSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 TEASLEY LN
Mailing Address - Street 2:APT #1824
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5288
Mailing Address - Country:US
Mailing Address - Phone:469-394-1568
Mailing Address - Fax:
Practice Address - Street 1:1408 TEASLEY LN
Practice Address - Street 2:APT #1824
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-5288
Practice Address - Country:US
Practice Address - Phone:469-394-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65336101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health