Individual
THOMAS GEORGE GLAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., M. ED
Contact information
Practice address
12497 TAMIAMI TRL S, SUITE #9, NORTH PORT, FL 34287-1447
(941) 429-0804
(941) 429-0814
Mailing address
2763 S SAN MATEO DR, NORTH PORT, FL 34288-8266
(941) 426-7608
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2188
FL
101YP2500X
Professional Counselor
Primary
MH5146
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2188
CAP CERTIFICATE
FL
01
—
MH5146
STATE LICENSE
FL
Enumeration date
12/28/2005
Last updated
07/02/2015
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