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Individual
GABRIEL GLASS
Active
Individual
GABRIEL GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
172V00000X
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
172V00000X
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172V00000X
MENTOR/COUNSELOR
MA
Enumeration date
01/23/2022
Last updated
01/23/2022
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