Healthcare Provider Details

I. General information

NPI: 1366598211
Provider Name (Legal Business Name): GLENN MURREN SIMPSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 SUN N LAKE BLVD SUITE A
SEBRING FL
33872-2166
US

IV. Provider business mailing address

4526 VIVIAN DR
SEBRING FL
33872-1722
US

V. Phone/Fax

Practice location:
  • Phone: 863-314-4357
  • Fax: 863-382-1279
Mailing address:
  • Phone: 863-382-9160
  • Fax: 863-382-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 2782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: