Provider Demographics
NPI:1043338239
Name:BETTE GLICKFIELD PHD PLLC
Entity type:Organization
Organization Name:BETTE GLICKFIELD PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED DELEGATE/ PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-535-8547
Mailing Address - Street 1:3160 PARKLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1823
Mailing Address - Country:US
Mailing Address - Phone:248-851-2622
Mailing Address - Fax:
Practice Address - Street 1:5600 WEST MAPLE RD
Practice Address - Street 2:STE D407
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3711
Practice Address - Country:US
Practice Address - Phone:248-851-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH81207OtherBCBSM
MI2080P0008XOtherBCBSM
MI680F331790OtherBCBS