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General NPI Number Information
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NPI Number | 1043671191
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Entity Type | Individual
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Provider Name | MARITA K GLASGOW LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5555 BOONE AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-3636
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Country | US
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Telephone | 651-774-0011
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Fax | 651-774-0606
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Provider Business Mailing Address
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Address Line | 1619 DAYTON AVE STE 108
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City | SAINT PAUL
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State | MN
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Zip | 55104-6276
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Country | US
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Telephone | 651-888-1286
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Fax | 651-391-2033
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4052
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License Number State | MN
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