MEDICARE: MR. PAUL GLENN NORMAN MBA, LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	201570	TX

General Provider Information

NPI Number	:	1053621862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL GLENN NORMAN MBA, LMFTA

Provider Business Mailing Address
First Line	:	2600 SOUTH SHORE BLVD.
Second Line	:	SUITE 300
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573
Country	:	US
Telephone Number	:	620-332-6459
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S SHORE BLVD
Second Line	:	SUITE 300
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2943
Country	:	US
Telephone Number	:	620-332-6459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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