Individual
GLENDA GILMER EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
505 COBBLESTONE CT STE A, MADISON, MS 39110-7570
(601) 707-5045
Mailing address
505 COBBLESTONE CT STE A, MADISON, MS 39110-7570
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2945
MS
Other
Enumeration date
05/13/2019
Last updated
05/07/2023
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