Provider Demographics
NPI:1144264227
Name:GLANTZ, MARY E (MA,SPE)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:MA,SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WOODBURY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-4730
Mailing Address - Country:US
Mailing Address - Phone:615-542-4945
Mailing Address - Fax:615-849-9536
Practice Address - Street 1:513 WOODBURY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-4730
Practice Address - Country:US
Practice Address - Phone:615-542-4945
Practice Address - Fax:615-849-9536
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health