Healthcare Provider Details

I. General information

NPI: 1952166696
Provider Name (Legal Business Name): MARLENA GLENN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10922 SCHUETZ RD
SAINT LOUIS MO
63146-5704
US

IV. Provider business mailing address

10922 SCHUETZ RD
SAINT LOUIS MO
63146-5704
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-2031
  • Fax:
Mailing address:
  • Phone: 636-498-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2024034047
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: