Healthcare Provider Details

I. General information

NPI: 1801191382
Provider Name (Legal Business Name): TAMARA GLOVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 W 34TH AVE
PINE BLUFF AR
71603-5500
US

IV. Provider business mailing address

3322 W 34TH AVE
PINE BLUFF AR
71603-5500
US

V. Phone/Fax

Practice location:
  • Phone: 870-329-1551
  • Fax:
Mailing address:
  • Phone: 870-606-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5167C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: