Organization
GLOW SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKELL DANIELS (CEO/LEAD THERAPIST)
(414) 628-0112
Entity
Organization
Contact information
Practice address
2300 W HOPKINS ST, MILWAUKEE, WI 53206-1749
(414) 218-1001
Mailing address
PO BOX 91352, MILWAUKEE, WI 53209-8352
(414) 628-0112
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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