Healthcare Provider Details

I. General information

NPI: 1023208410
Provider Name (Legal Business Name): TINA MARIE GLOVER PHD, CRC, LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

IV. Provider business mailing address

PO BOX 371
CONVERSE TX
78109-0371
US

V. Phone/Fax

Practice location:
  • Phone: 888-970-3562
  • Fax: 888-371-3076
Mailing address:
  • Phone: 888-970-3562
  • Fax: 888-371-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3006
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number175348
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3787
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02-11-101
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: