Healthcare Provider Details

I. General information

NPI: 1811907843
Provider Name (Legal Business Name): GLEN PAUL BEGROW JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 NEBRASKA ST
STURGEON BAY WI
54235-2249
US

IV. Provider business mailing address

169 N 9TH AVE UPPER
STURGEON BAY WI
54235-1729
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-2533
  • Fax: 920-746-2439
Mailing address:
  • Phone: 920-746-2533
  • Fax: 920-746-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7314-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7314-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7314-123
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7314-123
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7314-123
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7314-123
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number7314-123
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071602
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number071602
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number071602
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number071602
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: