Provider Demographics
NPI:1194116590
Name:GLIDDON, ELISABETH ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:ANN
Last Name:GLIDDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8577
Mailing Address - Country:US
Mailing Address - Phone:612-990-2383
Mailing Address - Fax:
Practice Address - Street 1:4758 PARK DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8577
Practice Address - Country:US
Practice Address - Phone:612-990-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist