Healthcare Provider Details

I. General information

NPI: 1215239926
Provider Name (Legal Business Name): MICKEY GLENN TENER M.S., LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7427 APENINNES ROAD
FT RILEY KS
66442-7037
US

IV. Provider business mailing address

7424 APENNINES DR
FT RILEY KS
66442-7151
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7311
  • Fax:
Mailing address:
  • Phone: 785-239-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number256
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: