Organization
GLASS HOUSE COUNSELING LLC
Active
Organization
GLASS HOUSE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISA MARVIN (OWNER)
(480) 519-5256
Entity
Organization
Contact information
Practice address
4111 E VALLEY AUTO DR, SUITE 201, MESA, AZ 85206-4605
(480) 519-5256
Mailing address
4150 E SIERRA MADRE AVE, GILBERT, AZ 85296-3084
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15935
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15935
LICENSE NUMBER
AZ
Enumeration date
01/11/2017
Last updated
01/11/2017
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