MEDICARE: LESLIE Z GLOVER LPC

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	101YP2500X	Professional Counselor	14498	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82279L	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1770527350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE Z GLOVER LPC

Provider Business Mailing Address
First Line	:	5656 N JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9641
Country	:	US
Telephone Number	:	903-589-9000
Fax Number	:	903-586-9200

Provider Business Practice Location Address
First Line	:	5656 N JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9641
Country	:	US
Telephone Number	:	903-589-9000
Fax Number	:	903-586-9200

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	03/31/2008

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Directions to “ LESLIE Z GLOVER LPC” Practice Location

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