Provider Demographics
NPI:1154961027
Name:GLOTZBACH, WILLIAM GAYLE (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GAYLE
Last Name:GLOTZBACH
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 JOHN MOORE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7850
Mailing Address - Country:US
Mailing Address - Phone:501-777-5527
Mailing Address - Fax:
Practice Address - Street 1:3633 JOHN MOORE RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7850
Practice Address - Country:US
Practice Address - Phone:501-777-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22955101YM0800X
MO2017043977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health