Healthcare Provider Details

I. General information

NPI: 1780837658
Provider Name (Legal Business Name): MERILLE CAMPBELL GLOVER M.A., MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 AUBURN BLVD STE. 2200
SACRAMENTO CA
95841-4167
US

IV. Provider business mailing address

4330 AUBURN BLVD STE. 2200
SACRAMENTO CA
95841-4167
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax: 916-473-5766
Mailing address:
  • Phone: 916-473-5764
  • Fax: 916-473-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberINTERN REGISTRATION:
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: